Myocardial and Atrial Strain Profiles in Pediatric Fontan Patients with Single Left Ventricle Using Two-Dimensional Speckle-Tracking Echocardiography: A Case-Control Study

Carmen Corina Șuteu ^1,2, Andreea Cerghit-Paler ¹, Liliana Gozar ^1,2

⁰Department of Pediatrics III, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu-Mureș, Romania.

Journal of Clinical Medicine +

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November 27, 2025

View abstract on PubMed

Summary

Pediatric Fontan patients with single left ventricle anatomy show subclinical myocardial and atrial dysfunction using strain imaging, even with normal ejection fraction. This advanced echocardiography detects early signs of ventricular dysfunction in high-risk children.

Area Of Science

Cardiology
Pediatric Cardiology
Echocardiography

Background

Children with single left ventricle (SLV) anatomy post-Fontan palliation face high risks of subclinical ventricular dysfunction.
Conventional echocardiography may not detect these early cardiac changes.

Purpose Of The Study

Assess myocardial and atrial strain profiles in pediatric Fontan patients with SLV using 2D-STE.
Compare these profiles with healthy controls.
Correlate strain findings with conventional echocardiographic and functional parameters.

Main Methods

A single-center study involving 66 pediatric patients who underwent echocardiography and a 6-minute walk test (6 MWT).
Comparison of conventional, 3D, and strain-based echocardiographic parameters between Fontan patients and controls.
Correlation analysis using ANCOVA, generalized additive models, and Pearson's correlation coefficient.

Main Results

Fontan patients exhibited significantly reduced 6 MWT distances and impaired post-test heart rate and oxygen saturation.
3D echocardiography showed lower left ventricular (LV) ejection fraction and higher LV volumes in Fontan patients.
Global longitudinal strain (LV_GLS) was significantly reduced in Fontan patients, alongside decreased left atrial (LA) reservoir and conduit strain.

Conclusions

Myocardial and atrial strain imaging effectively reveals subclinical cardiac dysfunction in pediatric Fontan patients.
Strain parameters offer a more sensitive assessment of ventricular function than conventional echocardiography in this population.
These findings highlight the utility of advanced echocardiographic techniques for early detection of dysfunction in high-risk pediatric cardiac patients.

Keywords:

Fontan circulation single left ventricle morphology speckle-tracking echocardiography