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Systolic and diastolic function in tricuspid valve atresia before the Fontan operation
G G Sandor1, M W Patterson, J G LeBlanc
1Department of Paediatrics and Cardiovascular Surgery, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada.
Insights
Young patients with tricuspid atresia show impaired systolic function despite normal diastolic function. This study highlights abnormalities in both load-dependent and independent systolic indexes before surgery.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Tricuspid atresia is a complex congenital heart defect requiring early intervention.
- Understanding preoperative cardiac function is crucial for surgical planning and patient outcomes.
Purpose of the Study:
- To assess systolic and diastolic cardiac function in pediatric patients with classic tricuspid atresia.
- To compare cardiac function parameters between patients and control subjects.
Main Methods:
- Cardiac catheterization was performed on 6 patients with tricuspid atresia and systemic-to-pulmonary shunts.
- Left ventricular volumes, mass, pressures, and myocardial stiffness were measured.
- Load-dependent and independent indexes of systolic function were analyzed.
Main Results:
- Patients had significantly larger left ventricular volumes and masses, and higher end-systolic and peak systolic stress.
- Rate-corrected mean velocity of fiber shortening was lower in patients.
- Diastolic function and myocardial stiffness were found to be normal.
Conclusions:
- Preoperative tricuspid atresia is associated with abnormal systolic function, including impaired contractility and altered load-dependent indexes.
- Diastolic function remains normal in these young patients.
- Findings suggest significant ventricular remodeling and altered mechanics prior to surgical correction.
Abstract:
Systolic and diastolic function were assessed at preoperative cardiac catheterization in 6 patients with classic tricuspid atresia and were compared with those in control subjects. All patients had systemic-to-pulmonary shunts. Left ventricular end-systolic and end-diastolic volumes and masses were significantly larger in the patient group; stroke volume and the ratio of volume to mass were also higher, but not significantly. Mean end-diastolic, peak systolic and end-systolic pressures were similar. Mean stress at end-systole and peak systole were significantly higher in the patient group. Operant chamber stiffness tended to be lower than normal, but was not statistically significant, and myocardial stiffness was normal for the patient group also. Indexes of systolic function were compared. The rate-corrected mean velocity of fiber shortening in the patient group was lower and its relation with stress at end-systole was variable with 4 abnormal patients. The ratio of stress at end-systole/end-systolic volume was significantly lower in patients. The duration of hospital stay did not correlate with end-diastolic volume or any parameter. Thus, this study found abnormalities of load-dependent and independent indexes of systolic function with normal diastolic function in young preoperative patients with tricuspid atresia.