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Longitudinal analysis of systemic ventricular function and atrioventricular valve function after the Fontan
Vincent Dahmen1,2, Paul Philipp Heinisch1,2, Helena Staehler1,2
1Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
Systemic ventricular function declines in patients with a dominant right ventricle (RV) after total cavopulmonary connection (TCPC) after 10 years, unlike those with a dominant left ventricle (LV). Atrioventricular valve (AVV) regurgitation is also more frequent in dominant RV patients, correlating with ventricular dysfunction.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Total cavopulmonary connection (TCPC) is a palliative surgical procedure for complex single-ventricle congenital heart defects.
- Long-term outcomes regarding systemic ventricular function and atrioventricular valve (AVV) regurgitation after TCPC require further investigation.
Purpose of the Study:
- To evaluate the longitudinal changes in systemic ventricular function and AVV regurgitation following TCPC.
- To compare outcomes between patients with a dominant right ventricle (RV) versus a dominant left ventricle (LV) after TCPC.
Main Methods:
- Retrospective analysis of 4219 echocardiographic examinations from 620 patients who underwent TCPC between 1994 and 2021.
- Assessment of systemic ventricular function and AVV regurgitation, stratified by dominant ventricle (RV or LV).
Main Results:
- No significant difference in transplant-free survival or ventricular function between dominant RV and LV groups within the first 10 years post-TCPC.
- Systemic ventricular function significantly worsened in the dominant RV group compared to the dominant LV group after 10 years.
- Atrioventricular valve regurgitation was more frequent and positively correlated with ventricular dysfunction in the dominant RV group.
Conclusions:
- While early outcomes are similar, long-term systemic ventricular function is inferior in dominant RV patients post-TCPC.
- Increased AVV regurgitation in dominant RV patients is associated with ventricular dysfunction, highlighting a need for closer monitoring.
