Left ventricular rotational abnormalities in adult patients with congenital heart disease late after Fontan procedure: detailed analysis from the CSONGRAD Registry and MAGYAR-Path Study.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular diagnosis and therapy Pub Date : 2025-06-30 Epub Date: 2025-06-26 DOI:10.21037/cdt-24-503

Attila Nemes, Renáta Halcsik, Árpád Kormányos, Nóra Ambrus, Kálmán Havasi

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引用次数: 0

Abstract

Background: The Fontan procedure (FP) is a surgical palliation diverting blood flow from the caval veins to the pulmonary artery. The FP is used in several congenital heart diseases (CHDs), for instance in the absence of a heart valve and/or in the presence of an abnormality of a heart chamber. Since little information is available on the cardiac mechanics of FP-operated patients, the present study aimed to determine three-dimensional speckle tracking echocardiography (3DSTE)-derived basal and apical left ventricular (LV) rotations in adult patients with CHD mainly affecting the right heart late after FP.

Methods: The present study comprised 15 CHD patients late after FP with a mean age of 32.6±8.0 years (5 males). Their results were compared to a group of 25 age- and gender-matched healthy individuals (mean age: 33.4±11.9 years, 8 males).

Results: Regarding the type of the procedure, bidirectional Glenn procedure (BDGP), modified Kreutzer procedure (MKP) and total cavopulmonary connection were performed as final palliative procedures in 2, 3 and 8 patients, respectively. Regarding the ventricular anatomy, hypoplastic right heart syndrome (HRHS), univentricular heart (UH) and tricuspid atresia were present in 3, 5 and 5 patients, respectively. With 3DSTE, regarding the procedure, only MKP patients showed normal LV ejection fraction (EF) due to increased LV end-diastolic volume (EDV), other groups showed mildly reduced LV-EF. With 3DSTE, regarding the ventricular anatomy, UH patients had the largest LV-EDV, but no differences could be detected in mildly reduced LV-EF values between the subgroups. Regarding the procedure, BDGP patients had larger basal and apical LV rotations compared to the other groups resulting in increased LV twist. Regarding the ventricular anatomy, HRHS patients had larger basal and apical LV rotations compared to the other groups resulting in increased LV twist.

Conclusions: In FP patients with CHD mainly affecting the right heart, on a group level, impaired LV-EF is associated with tendentiously lower LV twist due to reduced apical LV rotation, but characteristics of LV functional and rotational mechanics show substantial differences depending on the ventricular anatomy in CHD and the procedure performed.

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成年先天性心脏病患者Fontan手术后晚期左心室旋转异常：来自CSONGRAD注册和magyar路径研究的详细分析

背景：Fontan手术（FP）是一种将血流从腔静脉转移到肺动脉的手术缓解方法。FP用于几种先天性心脏病（CHDs），例如缺少心脏瓣膜和/或存在心脏腔异常。由于关于FP手术患者心脏力学的信息很少，本研究旨在确定三维斑点跟踪超声心动图（3DSTE）衍生的成人冠心病患者左心室基底和根尖旋转（LV），主要影响FP术后晚期的右心。方法：本研究纳入15例FP术后晚期冠心病患者，平均年龄32.6±8.0岁（男性5例）。将他们的结果与25名年龄和性别匹配的健康个体（平均年龄：33.4±11.9岁，男性8名）进行比较。结果：在手术方式上，双向Glenn手术（BDGP）、改良Kreutzer手术（MKP）和全腔肺连接分别为2例、3例和8例患者的最终姑息手术。在心室解剖方面，右心发育不良综合征（HRHS） 3例，单室心（UH） 5例，三尖瓣闭锁5例。在3DSTE手术中，只有MKP患者由于左室舒张末期容积（EDV）增加，左室射血分数（EF）正常，其他组左室射血分数轻度降低。对于3DSTE，关于心室解剖，UH患者的LV-EDV最大，但在轻度降低的LV-EF值在亚组之间没有差异。关于手术，与其他组相比，BDGP患者的左室基底和根尖旋转更大，导致左室扭转增加。在心室解剖方面，HRHS患者的左室基底和根尖旋转比其他组大，导致左室扭转增加。结论：在主要影响右心的FP患者中，在组水平上，由于左室心尖旋转减少，左室- ef受损与左室扭转倾向降低有关，但左室功能和旋转力学特征根据冠心病的心室解剖和手术表现出显著差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

4.20%

发文量

期刊介绍： The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.