Relationship of atrial function with cardiac function in the late phase more than 20 years after a Fontan operation

Atrial function in Fontan patients is unknown. Our goal was to report the relationship of atrial function with the cardiac index and atrial function and clinical outcome through longer follow-up periods.

Twelve patients were followed up for over 20 years after their first Fontan operation. Atrial function, including the expansion index, atrial ejection fraction, passive ejection fraction and active ejection fraction, was examined using cardiac computed tomography. The relationship of atrial function with the cardiac index and failing Fontan patients was analysed.

Twelve Fontan patients were included. The median follow-up period after the first Fontan operation was 27 (range, 21-33) years, and the median age of those examined was 33.5 (range, 24-60) years. There were 6 male patients (50%). The cardiac index showed a significant positive correlation with the expansion index (P = 0.02), the atrial ejection fraction (P = 0.035), and the active ejection fraction (P = 0.013). The expansion index (39.2 ± 19.6 vs 64.1 ± 3.9), atrial ejection fraction (26.6 ± 10.9 vs 39.0 ± 1.5%), booster pump (15.6 ± 9.0 vs 31.3 ± 3.5) and cardiac index (2.1 ± 0.3 vs 2.5 ± 0.2 L/min/m2) were significantly lower in patients with a history of arrhythmia than in patients without a history of arrhythmia (P < 0.05). The expansion index (23.5 ± 13.5 vs 59.5 ± 8.7), atrial ejection fraction (18.1 ± 8.6 vs 37.1 ± 3.7) and active ejection fraction (7.3 ± 2.7 vs 27.7 ± 5.2) were significantly lower in failing Fontan patients than in non-failing Fontan patients (P < 0.01).

Patients with atrial arrhythmia and signs of Fontan failure have lower atrial function than those without.