Mechanics of the Functionally Univentricular Heart—How Little Do We Understand and Why Does It Matter?

Grattan, Michael; Mertens, Luc

doi:10.1016/j.cjca.2015.11.001

Cited by 20 publications

(27 citation statements)

References 58 publications

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“…Newer measures of diastolic and systolic performance may be helpful in people with a Fontan circulation [51][52][53][54][55][56][57][58]. Deformation assessment is the most promising, but small studies to date have not shown consistent results or prognostic correlation [52,56,[59][60][61]. Transoesophageal echocardiography requires a general anaesthetic in young patients Table 1 Consensus Suggestions for Surveillance of ''Well" Patients With a Fontan Circulation*.…”

Section: Echocardiographymentioning

confidence: 99%

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Zentner

Celermajer

Gentles

et al. 2020

Heart, Lung and Circulation

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The Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a Fontan circulation, and their families to benefit from consensus agreement about management of the person with a Fontan circulation. The document was crafted with input from a multidisciplinary group of health care providers as well as individuals with a Fontan circulation and families. It is hoped that the shared common vision of long-term wellbeing will continue to drive improvements in care and quality of life in this patient population and eventually translate into improved survival.

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Section: Echocardiographymentioning

confidence: 99%

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Zentner

Celermajer

Gentles

et al. 2020

Heart, Lung and Circulation

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“…However, in contrary to the studies’ hypothesis we could not show significant impact of regional curvatures and wall thickness on regional deformation. Even though regional as well as global deformation parameters are load dependent and thus dependent on regional geometry, other factors like interventricular dependence, fiber orientation, conduction delays, fibrous tissue, or pericardial adhesions have obviously higher impact on the degree of regional reduced deformation.…”

Section: Discussionmentioning

confidence: 99%

“…fibrous tissue, or pericardial adhesions 15 have obviously higher impact on the degree of regional reduced deformation.…”

Section: Discussionmentioning

confidence: 99%

Ventricular mechanics in adolescent and adult patients with a Fontan circulation: Relation to geometry and wall stress

et al. 2018

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Background Patients with single ventricle physiology and Fontan circulation are at increased risk for late complications and reduced survival. The aim of the study was to investigate the correlation between ventricular geometry and systolic regional function in different underlying anatomic conditions in adolescent and adult Fontan‐palliated patients. Method In a retrospective cross‐sectional study, we measured 2D strain, ventricular diameters, ventricular volumes, ejection fraction (EF), global and segmental wall stress, and sphericity index. The same analyses were performed in 99 age‐ and gender‐matched healthy individuals. Results One hundred and one patients were included at a mean age of 21 (range 14–59) years. In comparison with healthy subjects, patients with Fontan circulation displayed larger ventricular volumes (153 ± 78 mL vs 116 ± 38 mL P < 0.05), reduced EF (43% ± 15% vs 55% ± 8% P < 0.05), reduced longitudinal (−13% ± 6% vs −21% ± 4% P < 0.05) and circumferential strain values (−15% ± 7% vs −22% ± 4% P < 0.05). Functionally single ventricles were more spherical (ratio of longitudinal to short‐axis diameters 1.3 ± 0.3 vs 1.7 ± 0.2 P < 0.05). Circumferential strain correlated well with global wall stress and the degree of sphericity (R2 = 0.320), while segmental strain did not correlate with segmental wall stress. The percentage of segments with akinesia was relatively high (16 ± 16% vs 0 ± 0% P < 0.05) indicating reduced segmental contractile function. Conclusion Functionally single ventricles after Fontan palliation have significantly reduced systolic regional and global function with a high intersegmental inhomogeneity. The underlying pathological mechanisms might be multifactorial, including ventricular geometry, sphericity, and regional contractile properties. Future studies are needed to investigate the role of ventricular geometry for clinical performance and outcome.

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“…Hence, a plausible explanation for the resting CI in Fontan patients being two-thirds of normal may be either a disparity in overall contractility in single-ventricle disorders or, more likely, a chamber-specific factor affecting the sarcomeric, extrasarcomeric, 21 or extracellular characteristics. 22 In our next series of experiments, 23 we evaluated the hemodynamic impact of nine cardiovascular perturbations while operating the model of a two-year-old Fontan patient in an open-loop mode, that is, without automatic feedback. In such a regime, several components of the Fontan circulation other than the total cavopulmonary connection (TCPC) actually had equal, or greater, impact on CI at rest.…”

Section: Introductionmentioning

confidence: 99%

Model-Based Comparison of the Normal and Fontan Circulatory Systems—Part III

Watrous

Chin

2017

World J Pediatr Congenit Heart Surg

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Mechanics of the Functionally Univentricular Heart—How Little Do We Understand and Why Does It Matter?

Cited by 20 publications

References 58 publications

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Ventricular mechanics in adolescent and adult patients with a Fontan circulation: Relation to geometry and wall stress

Model-Based Comparison of the Normal and Fontan Circulatory Systems—Part III

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