Preserved regional atrial contractile function following extra-atrial rather than intra-atrial type Fontan operation: a tissue Doppler imaging study.

Citation:
Lunze, F. I., W. Hui, M. Y. Abd El Rahman, V. Alexi-Meskishvili, R. Hetzer, P. E. Lange, F. Berger, and H. Abdul-Khaliq, "Preserved regional atrial contractile function following extra-atrial rather than intra-atrial type Fontan operation: a tissue Doppler imaging study.", Clinical research in cardiology : official journal of the German Cardiac Society, vol. 96, issue 5, pp. 264-71, 2007 May.

Abstract:

OBJECTIVE: To determine the univentricular and atrial function in patients following Fontan operation using tissue Doppler echocardiography (TDE).

SETTING: Hospital-based outpatient clinic and inpatient unit.

PATIENTS: Thirty-six patients (mean age 13 ys [2-34 ys]) after Fontan procedure and 30 healthy individuals matched for age and heart rate.

MAIN OUTCOME MEASURES: Pulsed wave Doppler derived Tei index was determined for global univentricular function. Tissue-Doppler derived strain rate and strain were measured for regional ventricular function. Different planimetric approaches were used to evaluate the global atrial function. Strain rate was measured for regional atrial contractile function.

RESULTS: The Tei index, reflecting global univentricular function, was significantly higher in Fontan patients than in the control group (p<0.001). The regional ventricular contractile function, which was determined by TDE derived strain and strain rate, was significantly lower in Fontan patients than in healthy controls (p<0.001). The global atrial function evaluated planimetrically, and the regional atrial function assessed using the TDE strain rate, were significantly lower in Fontan patients than in normal controls (p<0.001, p<0.001, respectively). A comparison of different types of Fontan operations with extra-atrial or intra-atrial baffle showed a better regional left atrial wall strain rate in patients with extra-atrial baffle than with intra-atrial baffle.

CONCLUSION: Patients who have undergone the Fontan procedure may present with altered ventricular and atrial performance independent of whether the extra-atrial or intraatrial type Fontan operation was performed. However, the regional atrial contractile function seems to be better preserved following the extra-atrial type Fontan operation.

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