Circulation, Vol 81, 118-127, Copyright © 1990 by American Heart Association
MH Gewillig, UR Lundstrom, JE Deanfield, C Bull, RC Franklin, TP Graham Jr and RK Wyse
Left ventricular dimensions and contractility were determined by
echocardiography in 33 patients with tricuspid atresia in 1985 and again in
1988. Eight patients remained palliated throughout the 3-year period;
neither the left ventricular end-diastolic diameter (153 +/- 15% of normal
vs. 157 +/- 19%, p = NS) nor a load-independent index of contractility
(rate-corrected velocity of shortening [VCFc]/end- systolic meridional
stress [ESSM]) changed. Eleven patients underwent a Fontan operation during
the study and were reevaluated at least 6 months after surgery; left
ventricular dimension decreased (130 +/- 15% vs. 114 +/- 19%, p less than
0.001), and the contractility index VCFc/ESSM improved (p less than 0.05).
Fourteen patients had undergone a Fontan operation 0.9-9.5 years (mean, 4.2
years) before initial examination in 1985. Over the 3-year period, left
ventricular dimensions did not change (121 +/- 17% vs. 118 +/- 11%, p =
NS), but the contractility index showed significant improvement (p less
than 0.01). Eight additional patients were studied just before and after a
Fontan operation to examine the early effects of surgery. Left ventricular
dimensions decreased from 130 +/- 14% to 100 +/- 13% by 10 days p less than
0.001) with no further change at 2 months. An inappropriate degree of
ventricular hypertrophy was observed in only the early postoperative
period. Successful Fontan repair results in rapid reduction of left
ventricular size, followed by regression of hypertrophy to a normal
mass-to-volume ratio. Operating at more favorable dimensions and loading
conditions results in an early increase in left ventricular contractility,
which further improves in the medium term follow-up.
ARTICLES
Impact of Fontan operation on left ventricular size and contractility in tricuspid atresia
Cardiothoracic Unit, Hospital For Sick Children, London, England.
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