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. 1991 Nov;66(5):375–378. doi: 10.1136/hrt.66.5.375

Abnormal patterns of intraventricular flow and diastolic filling after the Fontan operation: evidence for incoordinate ventricular wall motion.

D J Penny 1, M L Rigby 1, A N Redington 1
PMCID: PMC1024779  PMID: 1747299

Abstract

OBJECTIVE--To assess whether regional abnormalities of ventricular function are present in patients after the Fontan operation and to explore the implications of any such abnormalities for ventricular filling. DESIGN AND PATIENTS--Prospective study in which 25 patients after the Fontan operation were compared with 25 healthy controls and 12 patients with a univentricular atrioventricular connection, before the Fontan operation. INTERVENTIONS--Doppler echocardiography, with simultaneous electrocardiogram, phonocardiogram, and respirometer. RESULTS--Isovolumic relaxation time was significantly longer in patients after the Fontan operation than in normal children (p less than 0.001) or the preoperative patients (p = 0.001). Systolic intraventricular flow was detected in 60% of patients after the Fontan operation and in 42% of preoperative patients. After the Fontan operation 80% of patients showed intraventricular flow during isovolumic relaxation compared with 8% of normal children and none of the preoperative patients. CONCLUSIONS--Incoordinate ventricular relaxation is common after the Fontan operation. This may have important implications for ventricular diastolic filling, pulmonary blood flow, and cardiac output in these patients.

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Selected References

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

  1. Appleton C. P., Hatle L. K., Popp R. L. Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol. 1988 Aug;12(2):426–440. doi: 10.1016/0735-1097(88)90416-0. [DOI] [PubMed] [Google Scholar]
  2. Di Donato M., Barletta G., Mori F., Fantini F. Regional left ventricular wall motion abnormalities in chronic volume overload. Cathet Cardiovasc Diagn. 1983;9(5):453–462. doi: 10.1002/ccd.1810090504. [DOI] [PubMed] [Google Scholar]
  3. Fontan F., Baudet E. Surgical repair of tricuspid atresia. Thorax. 1971 May;26(3):240–248. doi: 10.1136/thx.26.3.240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fontan F., Kirklin J. W., Fernandez G., Costa F., Naftel D. C., Tritto F., Blackstone E. H. Outcome after a "perfect" Fontan operation. Circulation. 1990 May;81(5):1520–1536. doi: 10.1161/01.cir.81.5.1520. [DOI] [PubMed] [Google Scholar]
  5. Garrahy P. J., Kwan O. L., Booth D. C., DeMaria A. N. Assessment of abnormal systolic intraventricular flow patterns by Doppler imaging in patients with left ventricular dyssynergy. Circulation. 1990 Jul;82(1):95–104. doi: 10.1161/01.cir.82.1.95. [DOI] [PubMed] [Google Scholar]
  6. Gibson D. G., Traill T. A., Brown D. J. Abnormal ventricular function in patients with univentricular heart. Cineangiographic study. Herz. 1979 Apr;4(2):226–231. [PubMed] [Google Scholar]
  7. Hagler D. J., Seward J. B., Tajik A. J., Ritter D. G. Functional assessment of the Fontan operation: combined M-mode, two-dimensional and Doppler echocardiographic studies. J Am Coll Cardiol. 1984 Oct;4(4):756–764. doi: 10.1016/s0735-1097(84)80403-9. [DOI] [PubMed] [Google Scholar]
  8. Hall R. J., Doran J., Pusey C., McHaffie D., Gibson D. G. The effect of nitroglycerin, beta-blockade with acebutolol and isometric stress on incoordinate left ventricular function. Eur Heart J. 1982 Feb;3(1):23–28. doi: 10.1093/oxfordjournals.eurheartj.a061257. [DOI] [PubMed] [Google Scholar]
  9. Heusch G. Alpha-adrenergic mechanisms in myocardial ischemia. Circulation. 1990 Jan;81(1):1–13. doi: 10.1161/01.cir.81.1.1. [DOI] [PubMed] [Google Scholar]
  10. Little W. C., Downes T. R. Clinical evaluation of left ventricular diastolic performance. Prog Cardiovasc Dis. 1990 Jan-Feb;32(4):273–290. doi: 10.1016/0033-0620(90)90017-v. [DOI] [PubMed] [Google Scholar]
  11. Mirsky I. Assessment of diastolic function: suggested methods and future considerations. Circulation. 1984 Apr;69(4):836–841. doi: 10.1161/01.cir.69.4.836. [DOI] [PubMed] [Google Scholar]
  12. Sasson Z., Hatle L., Appleton C. P., Jewett M., Alderman E. L., Popp R. L. Intraventricular flow during isovolumic relaxation: description and characterization by Doppler echocardiography. J Am Coll Cardiol. 1987 Sep;10(3):539–546. doi: 10.1016/s0735-1097(87)80196-1. [DOI] [PubMed] [Google Scholar]
  13. de Leval M. R., Kilner P., Gewillig M., Bull C. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg. 1988 Nov;96(5):682–695. [PubMed] [Google Scholar]

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