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

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.