Ventricular performance before and after Fontan repair for univentricular atrioventricular connection: angiographic and radionuclide assessment

J Am Coll Cardiol. 1992 Oct;20(4):920-6. doi: 10.1016/0735-1097(92)90194-r.


Objectives: This study was designed to evaluate changes in ventricular volume, mass and cardiac function before and after creation of an atrial to pulmonary connection in patients with a univentricular atrioventricular connection.

Background: Intact systolic and diastolic performance is critical for successful establishment of an atrial dependent circulation, and few studies are available comparing cardiac performance before and after creation.

Methods: With the use of radionuclide blood pool imaging and ventricular cineangiography, 54 patients (mean age 6.4 +/- 3.4 years) were studied. Twenty-eight patients were investigated preoperatively and 36 greater than 1 year after repair and compared with a control population.

Results: Before operation, end-diastolic volume and wall mass were significantly increased compared with those of control subjects; however, the mass/volume ratio was normal (1.08 +/- 0.31 g/ml for the preoperative group; 0.97 +/- 0.19 for control subjects). Although end-diastolic volume returned to normal after the procedure, wall mass remained elevated and contributed to an elevated mass/volume ratio (1.20 +/- 0.38 g/ml). After the procedure, systemic vascular resistance index was significantly elevated compared with that before surgery or with that of control subjects (1,199 +/- 373, 2,120 +/- 645, 1,556 +/- 275 pre- and postrepair and control subjects, respectively). Radionuclide studies demonstrated that preoperative ejection fraction (52 +/- 9, 50 +/- 9, 60 +/- 8%), peak ejection (2.58 +/- 0.66, 2.95 +/- 0.81, 3.73 +/- 0.70 EDV/s) and peak filling rates (2.84 +/- 0.75, 2.75 +/- 0.79, 3.84 +/- 0.51 end-diastolic volumes [EDV/s]) were significantly reduced compared with those of control subjects and remained so after surgery.

Conclusions: These data suggest that systolic and diastolic function is depressed preoperatively in these patients, remains unchanged after the creation of an atrial-dependent circulation and is associated with an increased systemic vascular resistance. Long-term issues addressing preservation of cardiac function need to be prospectively studied.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Cineangiography
  • Female
  • Gated Blood-Pool Imaging
  • Heart / diagnostic imaging
  • Heart Atria / surgery*
  • Heart Defects, Congenital / diagnosis
  • Heart Defects, Congenital / physiopathology*
  • Heart Defects, Congenital / surgery*
  • Heart Ventricles / abnormalities
  • Humans
  • Male
  • Myocardial Contraction / physiology*
  • Pulmonary Artery / surgery*
  • Vascular Resistance / physiology
  • Ventricular Function / physiology*