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Abdulkarim M, Loomba RS, Zaidi SJ, Li Y, Wilson M, Roberson D, Farias JS, Flores S, Villarreal EG, Husayni T. Echocardiographic Strain to Predict Need for Transplant or Mortality in Fontan Patients with Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2024; 45:1475-1484. [PMID: 37204486 DOI: 10.1007/s00246-023-03187-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/14/2023] [Indexed: 05/20/2023]
Abstract
Despite recent advances, hypoplastic left heart syndrome (HLHS) patients subsequent to the Fontan still have significant morbidity and mortality. Some require heart transplant due to systemic ventricular dysfunction. Limited data exist on timing for transplant referral. This study aims to correlate systemic ventricular strain by echocardiography to transplant-free survival. HLHS patients who had Fontan palliation at our institution were included. Patients were divided into: 1) Required transplant or experienced mortality (composite end point); 2) Did not require transplant or survived. For those who experienced the composite endpoint, the last echocardiogram prior to the composite outcome was used, while for those who did not experience the composite endpoint the last echocardiogram obtained was used. Several qualitative and quantitative parameters were analyzed with focus on strain parameters. Ninety-five patients with HLHS Fontan palliation were identified. Sixty-six had adequate images and eight (12%) experienced transplant or mortality. These patients had greater myocardial performance index by flow Doppler (0.72 versus 0.53, p = 0.01), higher systolic/diastolic duration ratio (1.51 versus 1.13, p = 0.02), lower fractional area change (17.65 versus 33.99, p < 0.01), lower global longitudinal strain (GLS) (-8.63 versus - 17.99, p < 0.01), lower global longitudinal strain rate (GLSR) (- 0.51 versus - 0.93, p < 0.01), lower global circumferential strain (GCS) (-6.68 versus -18.25, p < 0.01), and lower (GCSR) global circumferential strain rate (-0.45 versus -1.01, p < 0.01). ROC analysis demonstrated predictive value for GLS - 7.6 (71% sensitive, 97% specific, AUC 81%), GLSR -0.58 (71% sensitive, 88% specific, AUC 82%), GCS - 10.0 (86% sensitive, 91% specific, AUC 82%), and GCSR -0.85 (100% sensitive, 71% specific, AUC 90%). GLS and GCS can help predict transplant-free survival in patients with hypoplastic left heart syndrome having undergone Fontan palliation. Higher strain values (closer to zero) may be a helpful tool in determining when transplant evaluation is warranted in these patients.
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Affiliation(s)
- Mubeena Abdulkarim
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Rohit S Loomba
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - S Javed Zaidi
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
- Department of Pediatric Cardiology, Carle BroMenn Medical Center, Normal, IL, USA
| | - Yi Li
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Melissa Wilson
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - David Roberson
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | | | - Saul Flores
- Division of Critical Care, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Enrique G Villarreal
- Tecnologico de Monterrey, Escuela de Medicina Y Ciencias de La Salud, Monterrey, Nuevo Leon, Mexico.
| | - Tarek Husayni
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
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Chowdhury SM, Atz AM, Graham EM, Bandisode VM, Rhodes JF, Nutting AC, Taylor C, Savage A, Hassid M, Kavarana M, Menick D. Low Ventricular Stiffness Is Associated With Suboptimal Outcomes in Patients With a Single Right Ventricle After the Fontan Operation: A Novel Phenotype. J Am Heart Assoc 2024; 13:e035601. [PMID: 39189484 DOI: 10.1161/jaha.124.035601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/09/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Despite a rigorous screening process, including cardiac catheterization, a subset of patients with a single right ventricle (SRV) demonstrates suboptimal short-term outcomes after the Fontan operation. The goal of this study was to perform a comprehensive assessment of diastolic function in pre-Fontan patients with an SRV using invasive reference-standard measures and determine their associations with post-Fontan outcomes. METHODS AND RESULTS Children aged 2 to 6 years with SRV physiology undergoing pre-Fontan heart catheterization were recruited prospectively. Patients were divided into those who had an optimal or suboptimal outcome. A suboptimal outcome was defined as length of stay ≥14 days or heart transplant/cardiac death in first year after Fontan. Patients underwent pressure-volume loop analysis using reference-standard methods. The measure of ventricular stiffness, β, was obtained via preload reduction. Cardiac magnetic resonance imaging for extracellular volume and serum draws for matrix metalloproteinase activity were performed. Of 19 patients with an SRV, 9 (47%) had a suboptimal outcome. Mean age was 4.2±0.7 years. Patients with suboptimal outcomes had lower ventricular stiffness (0.021 [0.009-0.049] versus 0.090 [0.031-0.118] mL-1; P=0.02), lower extracellular volume (25% [28%-32%] versus 31% [28%-33%]; P=0.02), and lower matrix metalloproteinase-2 (90 [79-104] versus 108 [79-128] ng/mL; P=0.01) compared with patients with optimal outcomes. The only invasive measure that had an association with suboptimal outcome was β (P=0.038). CONCLUSIONS Patients with an SRV with suboptimal outcome after the Fontan operation had lower ventricular stiffness and evidence of maladaptive extracellular matrix metabolism compared with patients with optimal outcome. This appears to be a novel phenotype that may have important clinical implications and requires further study.
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Affiliation(s)
- Shahryar M Chowdhury
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Andrew M Atz
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Eric M Graham
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Varsha M Bandisode
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - John F Rhodes
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Arni C Nutting
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Carolyn Taylor
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Andrew Savage
- Department of Pediatrics, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Marc Hassid
- Department of Anesthesia Medical University of South Carolina Charleston SC USA
| | - Minoo Kavarana
- Department of Surgery Medical University of South Carolina Charleston SC USA
| | - Donald Menick
- Department of Medicine, Division of Cardiology Medical University of South Carolina Charleston SC USA
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Systolic and diastolic function during cycling at the respiratory threshold between elderly and young healthy individuals. Sci Rep 2022; 12:3825. [PMID: 35264702 PMCID: PMC8907329 DOI: 10.1038/s41598-022-07933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/28/2022] [Indexed: 11/20/2022] Open
Abstract
The hemodynamic consequences of aging have been extensively investigated during maximal incremental exercise. However, less is known about the effects of aging on hemodynamics during submaximal steady-state exercise. The aim of the present investigation was to compare the hemodynamics of healthy elderly and young subjects during an exercise bout conducted at the gas threshold (GET) intensity. Two groups of healthy, physically active subjects were studied: the elderly group—EG (n = 11; > 60 years old) and the young group—YG (n = 13; < 35 years old). Both groups performed a 5-min rectangular exercise test at the GET intensity. Hemodynamics were measured using echocardiography. The main finding was that stroke volume responses were higher in the YG than the EG (72.5 ± 16.7 vs. 52.4 ± 8.4 ml, respectively). The increased stroke volume capacity in the YG was the consequence of a greater capacity to increase cardiac preload and contractility and, to a lesser extent, to reduce systemic vascular resistance. Importantly, the atrial contribution to ventricular diastolic filling was substantially higher in the YG when compared to the EG.
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Bassareo PP, Deidda M, Calcaterra G, Marras AR, Marras M, Saba L. Right ventricular diastolic function in post-surgical Tetralogy of Fallot patients: A pilot study to make a comparison between echocardiography and cardiac MRI. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Magnani S, Mulliri G, Roberto S, Sechi F, Ghiani G, Sainas G, Nughedu G, Vargiu R, Bassareo PP, Crisafulli A. Systolic and Diastolic Functions After a Brief Acute Bout of Mild Exercise in Normobaric Hypoxia. Front Physiol 2021; 12:650696. [PMID: 33967823 PMCID: PMC8103167 DOI: 10.3389/fphys.2021.650696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Acute hypoxia (AH) is a challenge to the homeostasis of the cardiovascular system, especially during exercise. Research in this area is scarce. We aimed to ascertain whether echocardiographic, Doppler, and tissue Doppler measures were able to detect changes in systolic and diastolic functions during the recovery after mild exercise in AH. Twelve healthy males (age 33.5 ± 4.8 years) completed a cardiopulmonary test on an electromagnetically braked cycle-ergometer to determine their maximum workload (Wmax). On separate days, participants performed randomly assigned two exercise sessions consisting in 3 min pedalling at 30% of Wmax: (1) one test was conducted in normoxia (NORMO) and (2) one in normobaric hypoxia with FiO2 set to 13.5% (HYPO). Hemodynamics were assessed with an echocardiographic system. The main result was that the HYPO session increased parameters related to myocardial contractility such as pre-ejection period and systolic myocardial velocity with respect to the NORMO test. Moreover, the HYPO test enhanced early transmitral filling peak velocities. No effects were detected for left ventricular volumes, as end-diastolic, end-systolic, and stroke volume were similar between the NORMO and the HYPO test. Results of the present investigation support the hypothesis that a brief, mild exercise bout in acute normobaric hypoxia does not impair systolic or diastolic functions. Rather, it appears that stroke volume is well preserved and that systolic and early diastolic functions are enhanced by exercise in hypoxia.
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Affiliation(s)
- Sara Magnani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Gabriele Mulliri
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Silvana Roberto
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fabio Sechi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanna Ghiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Gianmarco Sainas
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giorgio Nughedu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Romina Vargiu
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Pier Paolo Bassareo
- University College of Dublin, Mater Misericordiae University Teaching Hospital, Dublin, Ireland
| | - Antonio Crisafulli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
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Bassareo PP, Walsh KP, Murray JG. Cardiac MRI prior to liver biopsy in a Fontan patient: A case report. Clin Case Rep 2020; 8:1781-1785. [PMID: 32983495 PMCID: PMC7495785 DOI: 10.1002/ccr3.3016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/25/2020] [Accepted: 05/10/2020] [Indexed: 11/07/2022] Open
Abstract
The management of adults with complex congenital heart disease requires a multidisciplinary team (Heart Team).
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Affiliation(s)
- Pier Paolo Bassareo
- University College of DublinNational Adult Congenital Heart Disease ServiceMater Misericordiae University HospitalDublinIreland
| | - Kevin Patrick Walsh
- University College of DublinNational Adult Congenital Heart Disease ServiceMater Misericordiae University HospitalDublinIreland
| | - John Gerard Murray
- Department of RadiologyUniversity College of DublinMater Misericordiae University HospitalDublinIreland
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Gargiulo GD, Bassareo PP, Careddu L, Egidy-Assenza G, Angeli E, Calcaterra G. What have we learnt 50 years after the first Fontan procedure? J Cardiovasc Med (Hagerstown) 2020; 21:349-358. [PMID: 32141975 DOI: 10.2459/jcm.0000000000000951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Fontan procedure is often the only definitive palliative surgical option for patients with a variety of complex CHD sharing in common, a single, dominant ventricle. In recent decades, imaging and therapeutic improvement have played a crucial role in those patients in whom many complications can hamper their life. After 50 years from the first procedure, heart transplantation remains the only definitive treatment for those with a failing Fontan circulation.
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Affiliation(s)
- Gaetano D Gargiulo
- Pediatric Cardiac Surgery and GUCH Unit, University of Bologna, S.Orsola-Malpighi Hospital Bologna, Italy
| | - Pier P Bassareo
- University College of Dublin, Mater Misericordiae University Hospital and Our Lady's Children's Hospital Crumlin, Dublin, Republic of Ireland
| | - Lucio Careddu
- Pediatric Cardiac Surgery and GUCH Unit, University of Bologna, S.Orsola-Malpighi Hospital Bologna, Italy
| | - Gabriele Egidy-Assenza
- Pediatric Cardiac Surgery and GUCH Unit, University of Bologna, S.Orsola-Malpighi Hospital Bologna, Italy
| | - Emanuela Angeli
- Pediatric Cardiac Surgery and GUCH Unit, University of Bologna, S.Orsola-Malpighi Hospital Bologna, Italy
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Chen LJ, Zhang YQ, Bao SF, Zhong SW, Sun AM, Zhang ZF. Velocity vector imaging for the assessment of segmental ventricular function in children with a single right ventricle after cavopulmonary anastomosis. Curr Med Res Opin 2019; 35:203-210. [PMID: 29611724 DOI: 10.1080/03007995.2018.1460337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Ventricular function assessment is very important for the treatment and prognostic classification of children with a single right ventricle (SRV) after cavopulmonary anastomosis (CPA). However, unusual ventricular shapes can result in inaccurate measurements. The aim of this study was to evaluate velocity vector imaging (VVI) for assessing segmental ventricular function in children with SRV after CPA. METHODS Twenty-one children with SRV after CPA and 21 age- and sex-matched children with normal biventricular anatomy and function were included. The longitudinal velocity, displacement, strain and strain rate were measured in the two groups in six segments by VVI. The velocity, displacement, strain and strain rate of the SRVs were compared with max(dp/dt) measured during simultaneous cardiac catheterization in the SRV subjects. RESULTS The control group consisted of 13 males and 8 females (69% males) with a mean age of 6.7 ± 3.5 years and mean weight of 20.5 ± 6.5 kg, and the study group consisted of 13 males and 8 females with a mean age 6.7 ± 3.7 years and mean weight of 20.6 ± 6.8 kg. Age, weight and sex distribution were similar between the groups (all, p > .05). Strain and strain rate values in all six segments were significantly lower in the study group than in the control group (all, p < .05). The max(dp/dt) of the SRV was 522.84 ± 158.32 mmHg/s, and the strain rate of the basal segment at the rudimentary chamber correlated best with max(dp/dt) (r = 0.74, p < .01). CONCLUSIONS Segmental ventricular dysfunction was present in children with SRV after CPA, and it could be assessed using VVI.
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Affiliation(s)
- Li-Jun Chen
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yu-Qi Zhang
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Sheng-Fang Bao
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Shu-Wen Zhong
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Ai-Min Sun
- b Department of Medical Imaging , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Zhi-Fang Zhang
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
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Bassareo PP, Saba L, Marras AR, Mercuro G. Altered Aortic Upper Wall TDI Velocity Is Inversely Related with Left Ventricular Diastolic Function in Operated Tetralogy of Fallot. CONGENIT HEART DIS 2016; 11:598-605. [DOI: 10.1111/chd.12350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Pier Paolo Bassareo
- Department of Medical Sciences “M.Aresu”; University of Cagliari; Cagliari Italy
| | - Luca Saba
- Department of Radiology; University of Cagliari; Cagliari Italy
| | - Andrea R. Marras
- Department of Medical Sciences “M.Aresu”; University of Cagliari; Cagliari Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences “M.Aresu”; University of Cagliari; Cagliari Italy
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Zhong SW, Zhang YQ, Chen LJ, Wang SS, Li WH. Evaluation of Left Ventricular Volumes and Function by Real Time Three-Dimensional Echocardiography in Children with Functional Single Left Ventricle: A Comparison between QLAB and TomTec. Echocardiography 2015; 32:1554-63. [DOI: 10.1111/echo.12990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Shu-Wen Zhong
- Department of Pediatrics; Shanghai Children's Medical Center; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Yu-Qi Zhang
- Department of Pediatric Cardiology; Shanghai Children's Medical Center; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Li-Jun Chen
- Department of Pediatric Cardiology; Shanghai Children's Medical Center; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Shan-Shan Wang
- Department of Pediatrics; Shanghai Children's Medical Center; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Wei-Hua Li
- Department of Pediatrics; Shanghai Children's Medical Center; Shanghai Jiaotong University School of Medicine; Shanghai China
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Assessment of longitudinal systolic ventricular dysfunction and asynchrony using velocity vector imaging in children with a single right ventricle. Pediatr Cardiol 2014; 35:1147-54. [PMID: 24771060 DOI: 10.1007/s00246-014-0908-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/26/2014] [Indexed: 11/27/2022]
Abstract
Assessment of ventricular dysfunction and asynchrony is very important in predicting the outcome for children with a single right ventricle. However, the assessment is inaccurate and subjective because of the unusual ventricular shape. This study aimed to evaluate the feasibility and clinical value of velocity vector imaging for assessing longitudinal systolic ventricular dysfunction and intraventricular asynchrony in children with a single right ventricle. The study enrolled 36 children with a single right ventricle and 36 age-matched children with a normal heart. Peak systolic velocity, peak displacement, strain, strain rate, time to peak systolic velocity, and time to peak systolic strain were measured via velocity vector imaging using the Siemens Sequoia C512 echocardiography instrument. The maximum positive rate of ventricular pressure change (Max [dp/dt]) was obtained by cardiac catheterization for all the children with a single right ventricle. In the children with a single right ventricle, the maximal temporal differences and the standard deviations of the times to peak systolic velocity and peak systolic strain were higher (P < 0.01) than in the children with a normal heart. Moreover, the strain and strain rate values were significantly lower in all six segments (P < 0.05). The strain rate of the basal segment adjacent to the rudimentary chamber correlated best with Max (dp/dt) (r = 0.86; P < 0.01). Longitudinal systolic dysfunction and intraventricular asynchrony could be assessed accurately using velocity vector imaging in children with a single right ventricle.
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Chowdhury SM, Butts RJ, Buckley J, Hlavacek AM, Hsia TY, Khambadkone S, Baker GH. Comparison of pressure-volume loop and echocardiographic measures of diastolic function in patients with a single-ventricle physiology. Pediatr Cardiol 2014; 35:998-1006. [PMID: 24584211 PMCID: PMC4082737 DOI: 10.1007/s00246-014-0888-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/19/2014] [Indexed: 01/08/2023]
Abstract
Echocardiographic measurements of diastolic function have not been validated against invasive pressure-volume loop (PVL) analysis in the single-ventricle population. The authors hypothesized that echocardiographic measures of diastolic function would correlate with PVL indices of diastolic function in patients with a single-ventricle physiology. The conductance-derived PVL measures of diastolic function included the isovolumic relaxation time constant (τ), the maximum rate of ventricular pressure decline (peak -dP/dt), and a measure of passive diastolic stiffness (μ). The echocardiographic measures included Doppler inflow patterns of the dominant atrioventricular valve (DAVV), tissue Doppler velocities (TDI) at the lateral (ventricular free wall) component of the DAVV annulus, and the TDI-derived isovolumic relaxation time (IVRT'). The correlation between PVL and echocardiographic measures was examined. The study enrolled 13 patients at various stages of surgical palliation. The median age of the patients was 3 years (range 3 months to 19 years). τ correlated well with Doppler E:A (r = 0.832; p = 0.005), lateral E:E' (r = 0.747; p = 0.033), and IVRT' (r = 0.831; p = 0.001). Peak -dP/dt also was correlated with IVRT' (r = 0.609; p = 0.036), and μ also was correlated with IVRT' (r = 0.884; p = 0.001). This study represents the first-ever comparison of diastolic echocardiographic and PVL indices in a single-ventricle population. The findings show that Doppler E:A, lateral E:E', and IVRT' correlate well with PVL measures of diastolic function. This study supports further validation of echocardiographic measures of diastolic function versus PVL measures of diastolic function in the single-ventricle population.
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Affiliation(s)
- Shahryar M Chowdhury
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Avenue, MSC 915, Charleston, SC, 29425, USA,
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Factors influencing adaptation and performance at physical exercise in complex congenital heart diseases after surgical repair. BIOMED RESEARCH INTERNATIONAL 2014; 2014:862372. [PMID: 24822218 PMCID: PMC4009320 DOI: 10.1155/2014/862372] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 03/27/2014] [Indexed: 01/02/2023]
Abstract
In the last thirty years, steady progress in the diagnostic tools and care of subjects affected by congenital heart diseases (CHD) has resulted in a significant increase in their survival to adulthood, even for those affected by complex CHD. Based on these premises, a number of teenagers and adults affected by corrected (surgically or through interventional techniques) CHD ask to be allowed to undertake sporting activities, both at a recreational and competitive level. The purpose of this review is to examine the mechanisms influencing the adaption at physical exercise of patients suffering from complex CHD. The conclusion is that even if there are some modest risks with exercise, they should be seen in perspective, and the life-long benefits of regular exercise on general health, mood, and well-being should be emphasized.
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Atrial and ventricular mechanics in patients after Fontan-type procedures: atriopulmonary connection versus extracardiac conduit. J Am Soc Echocardiogr 2014; 27:666-74. [PMID: 24637059 DOI: 10.1016/j.echo.2014.01.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Differences in systemic venous flow dynamics and energy losses exist in various Fontan-type procedures, which may affect atrial and ventricular filling. The aim of this study was to test the hypothesis that atrial and ventricular mechanics differ between two types of Fontan procedures, atriopulmonary connection (APC) and extracardiac conduit, which have distinctly different systemic venous hemodynamics. METHODS This was a cross-sectional, case-control study of 28 Fontan patients (13 with APC, 15 with extracardiac conduit) aged 19.8 ± 6.5 years and 26 healthy controls. Atrial and systemic ventricular myocardial deformation was determined using speckle-tracking echocardiography, while ventricular volumes and systolic dyssynchrony index were assessed using three-dimensional echocardiography. RESULTS Compared with controls, patients had significantly lower values of global ventricular longitudinal, circumferential, and radial systolic strain in all three directions, reduced systolic and early diastolic strain rates (SRs) in more than one dimension, lower ejection fractions, and worse ventricular dyssynchrony. For atrial deformation, patients had lower global and positive strain and conduit and reservoir SRs and delayed electromechanical coupling. Among patients, those with APC had significantly lower ventricular longitudinal strain and early diastolic SRs, worse ventricular dyssynchrony, and reduced atrial positive and negative strain and conduit and active contractile SRs. Atrial global strain (r = 0.60, P = .001) and conduit SR (r = 0.49, P = .008) correlated positively with systemic ventricular early diastolic SR. CONCLUSIONS Atrial and ventricular mechanics are impaired in patients after Fontan-type operation, which is worse with APC than extracardiac conduit.
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Priyadarshini A, Saxena A, Patel C, Paul VK, Lodha R, Airan B. Myocardial perfusion abnormalities in patients occurring more than 1 year after successful univentricular (Fontan surgery) and biventricular repair (complete repair of tetralogy of Fallot). Pediatr Cardiol 2013; 34:786-94. [PMID: 23064840 DOI: 10.1007/s00246-012-0531-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 09/12/2012] [Indexed: 10/27/2022]
Abstract
The outcome of children born with cyanotic congenital heart disease has markedly improved over the years. Follow up is recommended for most post-operated cases as complications may occur over long term. One of the complications is the development of ventricular dysfunction, often seen after a successful Fontan surgery (or one of its modifications) for single ventricle. The aim of this study was to determine the prevalence of myocardial perfusion abnormalities in the ventricular myocardium of asymptomatic patients, older than 8 years of age, who had earlier undergone either a univentricular palliation (modified Fontan procedure) or a biventricular repair for tetralogy of Fallot, more than a year ago. All eligible patients underwent screening electrocardiogram (to rule out rhythm disturbance) and echocardiography. Patients with ventricular ejection fraction of more than 50 % by echocardiography were included. Enrolled patients were subjected to gated stress-rest myocardial perfusion imaging using Technitium-99m tetrofosmin single photon emission-computerized tomography (SPECT). Ventricular ejection fraction was also calculated from gated rest study. For the Fontan group, we also analyzed data to see if the morphology of the systemic ventricle would make a difference as far as myocardial perfusion was concerned. Twenty-six patients were enrolled (11 had undergone Fontan surgery and 15 had complete repair of tetralogy of Fallot). Seven of 11 patients in the Fontan group had myocardial perfusion defects (63.6 %) as against none in the repaired tetralogy of Fallot group (p < 0.001). The ejection fraction was within normal range in both the groups; it was statistically higher in the post tetralogy of Fallot repair group (p < 0.04). There were two subgroups in the post Fontan group depending on the morphology of systemic ventricle-left (4 patients) and non-left (7 patients). Higher number and larger size of perfusion defects were present in the non-left ventricular systemic ventricle morphology as compared with left ventricular morphology, but this difference did not reach statistical significance. Myocardial perfusion defects are common in patients who have undergone univentricular repair more than one year ago in contrast to patients who had a biventricular repair for tetralogy of Fallot. In the Fontan group, the morphology of the systemic ventricle was not predictive of prevalence of perfusion defect.
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Affiliation(s)
- A Priyadarshini
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Petko C, Hansen JH, Scheewe J, Rickers C, Kramer HH. Comparison of Longitudinal Myocardial Deformation and Dyssynchrony in Children with Left and Right Ventricular Morphology after the Fontan Operation Using Two-dimensional Speckle Tracking. CONGENIT HEART DIS 2011; 7:16-23. [DOI: 10.1111/j.1747-0803.2011.00607.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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