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. 2000 Apr;83(4):420–424. doi: 10.1136/heart.83.4.420

Serial assessment of left ventricular diastolic function after Fontan procedure

Y Cheung 1, D Penny 1, A Redington 1
PMCID: PMC1729362  PMID: 10722541

Abstract

OBJECTIVE—To assess longitudinal changes in systemic ventricular diastolic function late after the Fontan procedure.
DESIGN AND PATIENTS—Prospective study of 13 patients at 2.8 (2.0) years (early) and again at 11.4 (2.0) years (late) after the Fontan procedure by Doppler echocardiography with simultaneous ECG, phonocardiogram, and respirometer.
SETTING—Tertiary paediatric cardiac centre.
RESULTS—The isovolumic relaxation time (IVRT) was significantly longer, and E wave deceleration time, E and A wave velocities, and E:A velocity ratio were reduced compared to normal both early and late after the procedure. The mean (SD) z score of IVRT decreased significantly from +2.50 (1.00) to +1.24 (0.80) (p = 0.002), and the z score of the E wave deceleration time decreased from −1.69 (1.31) to −2.40 (1.47) (p = 0.03) during follow up. The A wave deceleration time also tended to decrease (early 80 (12) ms v late 73 (11) ms, p = 0.13) with increased follow up. There were no changes of the E and A wave velocities and E:A velocity ratio. The E wave velocity was inversely related to IVRT both early (r = −0.82, p = 0.001) and late (r = −0.59, p = 0.034) after the operation. The prevalence of diastolic flow during isovolumic relaxation decreased from 85% (11/13) to 38% (5/13) (p = 0.04), while that of mid diastolic flow increased from 23% (3/13) to 77% (10/13) (p = 0.02) between the two assessments.
CONCLUSIONS—Left ventricular diastolic function remains highly abnormal late after the Fontan procedure. The longitudinal changes demonstrated on follow up are compatible with reduction of left ventricular compliance in addition to persisting abnormalities of relaxation.


Keywords: diastolic function; Fontan procedure

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Figure 1  .

Figure 1  

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Vertical scatter plots of the z score of the IVRT at first and second assessments. The error bar represents mean (SEM).

Figure 2  .

Figure 2  

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Scatter plot of the early diastolic flow velocity (E wave velocity) against IVRT early (closed circle) and late (open triangle) after the Fontan procedure, showing a significant inverse relation.

Figure 3  .

Figure 3  

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Pulsed wave Doppler velocity tracing with simultaneous ECG, phonocardiogram (PCG), and respirometer (RESP) in a patient assessed late after the Fontan operation. Mid diastolic antegrade flow (L) is shown, which occurs between the early diastolic and atrial systolic flow. Isovolumic relaxation flow, present also in this patient, is faintly shown. S1, first heart sound; S2, second heart sound.

Selected References

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