Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1990 May;63(5):304–307. doi: 10.1136/hrt.63.5.304

Early diastolic clicks after the Fontan procedure for double inlet left ventricle: anatomical and physiological correlates.

A N Redington 1, K Y Chan 1, J S Carvalho 1, E A Shinebourne 1
PMCID: PMC1024482  PMID: 2278802

Abstract

M mode echocardiograms and simultaneous phonocardiograms were recorded in four patients with early diastolic clicks on auscultation. All had double inlet left ventricle and had undergone the Fontan procedure with closure of the right atrioventricular valve orifice by an artificial patch. The phonocardiogram confirmed a high frequency sound occurring 60-90 ms after aortic valve closure and coinciding with the time of maximal excursion of the atrioventricular valve patch towards the ventricular mass. One patient had coexisting congenital complete heart block. The M mode echocardiogram showed "reversed" motion of the patch towards the right atrium during atrial contraction. Doppler flow studies showed that coincident with this motion there was forward flow in the pulmonary artery with augmentation when atrial contraction coincided with ventricular systole. The early diastolic click in these patients was explained by abrupt cessation of the motion of the atrioventricular valve patch towards the ventricular mass in early diastole. In one patient atrial contraction led to a reversal of this motion and was associated with forward flow in the pulmonary artery.

Full text

PDF
304

Images in this article

305Image
on p.305
305Image
on p.305
305Image
on p.305
306Image
on p.306
307Image
on p.307

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Craige E., Fortuin N. J. Letter: Opening snap in mitral stenosis. Am Heart J. 1975 Jan;89(1):128–128. doi: 10.1016/0002-8703(75)90024-1. [DOI] [PubMed] [Google Scholar]
  2. Craige E. On the genesis of heart sounds. Contributions made by echocardiographic studies. Circulation. 1976 Feb;53(2):207–209. doi: 10.1161/01.cir.53.2.207. [DOI] [PubMed] [Google Scholar]
  3. Crews T. L., Pridie R. B., Benham R., Leatham A. Auscultatory and phonocardiographic findings in Ebstein's anomaly. Correlation of first heart sound with ultrasonic records of tricuspid valve movement. Br Heart J. 1972 Jul;34(7):681–687. doi: 10.1136/hrt.34.7.681. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. DiSessa T. G., Child J. S., Perloff J. K., Wu L., Williams R. G., Laks H., Friedman W. F. Systemic venous and pulmonary arterial flow patterns after Fontan's procedure for tricuspid atresia or single ventricle. Circulation. 1984 Nov;70(5):898–902. doi: 10.1161/01.cir.70.5.898. [DOI] [PubMed] [Google Scholar]
  5. Keren G., Sonnenblick E. H., LeJemtel T. H. Mitral anulus motion. Relation to pulmonary venous and transmitral flows in normal subjects and in patients with dilated cardiomyopathy. Circulation. 1988 Sep;78(3):621–629. doi: 10.1161/01.cir.78.3.621. [DOI] [PubMed] [Google Scholar]
  6. Kreutzer G. O., Vargas F. J., Schlichter A. J., Laura J. P., Suarez J. C., Coronel A. R., Kreutzer E. A. Atriopulmonary anastomosis. J Thorac Cardiovasc Surg. 1982 Mar;83(3):427–436. [PubMed] [Google Scholar]
  7. Leung M. P., Benson L. N., Smallhorn J. F., Williams W. G., Trusler G. A., Freedom R. M. Abnormal cardiac signs after Fontan type of operation: indicators of residua and sequelae. Br Heart J. 1989 Jan;61(1):52–58. doi: 10.1136/hrt.61.1.52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Nakazawa M., Nakanishi T., Okuda H., Satomi G., Nakae S., Imai Y., Takao A. Dynamics of right heart flow in patients after Fontan procedure. Circulation. 1984 Feb;69(2):306–312. doi: 10.1161/01.cir.69.2.306. [DOI] [PubMed] [Google Scholar]
  9. Nakazawa M., Nojima K., Okuda H., Imai Y., Nakanishi T., Kurosawa H., Takao A. Flow dynamics in the main pulmonary artery after the Fontan procedure in patients with tricuspid atresia or single ventricle. Circulation. 1987 Jun;75(6):1117–1123. doi: 10.1161/01.cir.75.6.1117. [DOI] [PubMed] [Google Scholar]
  10. Rodbard S., Libanoff A. J. The mitral closing snap. Am Heart J. 1972 Jan;83(1):19–26. doi: 10.1016/0002-8703(72)90102-0. [DOI] [PubMed] [Google Scholar]
  11. Wooley C. F., Fontana M. E., Kilman J. W., Ryan J. M. Tricuspid stenosis. Atrial systolic murmur, tricuspid opening snap, and right atrial pressure pulse. Am J Med. 1985 Mar;78(3):375–384. doi: 10.1016/0002-9343(85)90327-4. [DOI] [PubMed] [Google Scholar]
  12. Zaky A., Grabhorn L., Feigenbaum H. Movement of the mitral ring: a study in ultrasoundcardiography. Cardiovasc Res. 1967 Apr;1(2):121–131. doi: 10.1093/cvr/1.2.121. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES