scholarly journals Functional state following the Fontan procedure

2009 ◽  
Vol 19 (4) ◽  
pp. 320-330 ◽  
Author(s):  
Ismee A. Williams ◽  
Lynn A. Sleeper ◽  
Steven D. Colan ◽  
Minmin Lu ◽  
Elizabeth A. Stephenson ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Functional State ◽  
Diastolic Pressure ◽  
Fontan Procedure ◽  
Fontan Circulation ◽  
Functional Score ◽  
Lower Income ◽  
Cross Sectional ◽  
Ventricular Ejection Fraction ◽  
Cavopulmonary Anastomosis

AbstractBackgroundDespite improvements in outcomes after completion of the Fontan circulation, long-term functional state varies. We sought to identify pre- and postoperative characteristics associated with overall function.Methods and ResultsWe analyzed data from 476 survivors with the Fontan circulation enrolled in the Pediatric Heart Network Fontan Cross-sectional Study. Mean age at creation of the Fontan circulation was 3.4 plus or minus 2.1 years, with a range from 0.7 to 17.5 years, and time since completion was 8.7 plus or minus 3.4 years, the range being from 1.1 to 17.3 years. We calculated a functional score for the survivors by averaging the percentile ranks of ventricular ejection fraction, maximal consumption of oxygen, the physical summary score for the Child Health Questionnaire, and a function of brain natriuretic peptide. The mean calculated score was 49.5 plus or minus 17.3, with a range from 3 to 87. After adjustment for time since completion of the circulation, we found that a lower score, and hence worse functional state, was associated with: right ventricular morphology (p less than 0.001), higher ventricular end-diastolic pressure (p equals 0.003) and lower saturations of oxygen (p equals 0.047) prior to completion of the Fontan circulation, lower income for the caregiver (p equals 0.003), and, in subjects without a prior superior cavopulmonary anastomosis, arrhythmias after completion of the circulation (p equals 0.003). The model explained almost one-fifth (18%) of the variation in the calculated scores. The score was not associated with surgical centre, sex, age, weight, fenestration, or the period of stay in hospital after completion of the Fontan circuit. A validation model, using 71 subjects randomly excluded from initial analysis, weakly correlated (R equals 0.17, p equals 0.16) with the score calculated from the dataset.ConclusionsRight ventricular morphology, higher ventricular end-diastolic pressure and lower saturations of oxygen prior to completion of the Fontan circuit, lower income for the provider of care, and arrhythmias after creation of the circuit, are all associated with a worse functional state. Unmeasured factors also influence outcomes.

scholarly journals Right ventricular ejection fraction as predictor of outcome in acute heart failure using RV ellipsoid model: A retrospective analysis of a prospective cross-sectional study

2021 ◽  
Vol 10 ◽  
pp. 204800402110027
Author(s):  
Eshan Ashcroft ◽  
Otar Lazariashvili ◽  
Jonathan Belsey ◽  
Max Berrill ◽  
Pankaj Sharma ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Retrospective Analysis ◽  
Cross Sectional Study ◽  
Volume Estimation ◽  
Sectional Study ◽  
Cross Sectional ◽  
Ventricular Ejection Fraction ◽  
Rv Function

Objectives The right ventricular (RV) function is an important prognostic factor in acute and chronic heart failure (HF). Echocardiography is an essential imaging modality with established parameters for RV function which are useful and easy to perform. However, these fail to reflect global RV volumes due to reliability on one acoustic window. It is therefore attractive to calculate RV volumes and ejection fraction (RVEF/E) using an ellipsoid geometric model which has been validated against MRI in healthy adults but not in the HF patients. Design This is a retrospective analysis of a prospective cross-sectional study enrolling 418 consecutive patients with symptoms of HF according to a predefined study protocol. All patients underwent echocardiographic assessment of RV function using Tricuspid Annular Plane Systolic Excursion (TAPSE) and RV fractional area change (RVFAC) and RVEF/E. Setting Single centre study with multiple locations for acute in-patients including high dependency units. Participants Patients with acute or exacerbation of chronic HF older than 18 y.o. Main outcome measures Ability of RVEF/E to predict patient outcomes compared with two established parameters of RV function over two-year follow-up period. Primary outcome measure was all-cause mortality. Results RVEF/E is equal to TAPSE & RVFAC in predicting outcome (p ≤ 0.01 vs p ≤ 0.01) and provides additional benefit of RV volume estimation based on standard 2D echo measurements. Conclusions In this study we have shown that RVEF/E derived from ellipsoid model is not inferior to well established measures of RV function as a prognostic indicator of outcome in the acute HF.

Abstract 16964: Triplane Measurement of Fractional Area Change to Assess Single Right Ventricular Function

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Muhammad Y Qureshi ◽  
Chelsea L Reece ◽  
Angela R Miller ◽  
Rebecca K Lindquist ◽  
Patrick W O’Leary
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Short Axis ◽  
Single Plane ◽  
Ventricular Ejection Fraction ◽  
Area Change ◽  
Fractional Area Change ◽  
Fractional Area ◽  
Cavopulmonary Anastomosis ◽  
3D Echo

Background: Echocardiographic (echo) functional assessment of single systemic right ventricle (RV) lacks a reliable parameter and does not provide a substitute of volumetric ejection fraction (EF). RV volumes by 3D-echo are challenging and not widely used. Apical RV fractional area change (FAC) has shown some relation to CMR EF, but the strength of correlation has been suboptimal. Adding additional planes to apical FAC may improve this correlation. Our objective was to assess correlation of triplane FAC (apical, short-axis, and inflow-outflow) with CMR EF and to compare the tri- and single plane methods of measuring FAC to each other. Methods: Subjects with hypoplastic left heart syndrome (after superior or total cavopulmonary anastomosis) were prospectively recruited. CMR was performed and right ventricular ejection fraction was calculated. Transthoracic echo studies were performed close to the time of the CMR scan (median interval: 1 d). FAC was measured in apical 4-chamber view, parasternal short axis view at the mid ventricular level, and para-apical right ventricular inflow-outflow view. Triplane FAC was calculated by the average of the three FAC. Comparison was made between FAC and CMR-derived ejection fraction. Results: A total of 25 subjects underwent testing. Triplane FAC could not be assessed in 5, due to lack of optimal acoustic windows. Mean age was 10 ± 8 y (range 9 m to 24 y). Out of the uniplanar methods, apical FAC had the closest relationship to CMR EF. Triplane FAC showed even better correlation coefficient and R 2 values; although in this small group the difference did not reach significance. Results are summarized in the Table. Conclusion: In patients with single systemic RV, triplane FAC offers improved correlation with CMR EF relative to single plane evaluations. This approach may be useful if 3D echo is unavailable or of suboptimal quality and warrants further study.

scholarly journals Cardiac performance and quality of life in patients who have undergone the Fontan procedure with and without prior superior cavopulmonary connection

2012 ◽  
Vol 23 (3) ◽  
pp. 335-343 ◽  
Author(s):  
Andrew M. Atz ◽  
Thomas G. Travison ◽  
Brian W. McCrindle ◽  
Lynn Mahony ◽  
Andrew C. Glatz ◽  
...  
Keyword(s):  
Fontan Procedure ◽  
Cross Sectional Study ◽  
Univentricular Heart ◽  
P Value ◽  
Cross Sectional ◽  
Ventricular Performance ◽  
Cavopulmonary Anastomosis ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Fontan Surgery ◽  
Cavopulmonary Connection

AbstractBackgroundA superior cavopulmonary connection is commonly performed before the Fontan procedure in patients with a functionally univentricular heart. Data are limited regarding associations between a prior superior cavopulmonary connection and functional and ventricular performance late after the Fontan procedure.MethodsWe compared characteristics of those with and without prior superior cavopulmonary connection among 546 subjects enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study. We further compared different superior cavopulmonary connection techniques: bidirectional cavopulmonary anastomosis (n equals 229), bilateral bidirectional cavopulmonary anastomosis (n equals 39), and hemi-Fontan (n equals 114).ResultsA prior superior cavopulmonary connection was performed in 408 subjects (75%); the proportion differed by year of Fontan surgery and centre (p-value less than 0.0001 for each). The average age at Fontan was similar, 3.5 years in those with superior cavopulmonary connection versus 3.2 years in those without (p-value equals 0.4). The type of superior cavopulmonary connection varied by site (p-value less than 0.001) and was related to the type of Fontan procedure. Exercise performance, echocardiographic variables, and predominant rhythm did not differ by superior cavopulmonary connection status or among superior cavopulmonary connection types. Using a test of interaction, findings did not vary according to an underlying diagnosis of hypoplastic left heart syndrome.ConclusionsAfter controlling for subject and era factors, most long-term outcomes in subjects with a prior superior cavopulmonary connection did not differ substantially from those without this procedure. The type of superior cavopulmonary connection varied significantly by centre, but late outcomes were similar.

scholarly journals Pathophysiology, adaptation, and imaging of the right ventricle in Fontan circulation

2018 ◽  
Vol 315 (6) ◽  
pp. H1779-H1788 ◽  
Author(s):  
Matthew D. Files ◽  
Bhawna Arya
Keyword(s):  
Right Ventricle ◽  
Fontan Procedure ◽  
Management Strategies ◽  
Disease Process ◽  
Distinct Pattern ◽  
Fontan Circulation ◽  
Cavopulmonary Anastomosis ◽  
Abnormal Volume ◽  
In Series ◽  
The Right

The Fontan procedure, which creates a total cavopulmonary anastomosis and represents the final stage of palliation for hypoplastic left heart syndrome, generates a unique circulation relying on a functionally single right ventricle (RV). The RV pumps blood in series around the systemic and pulmonary circulation, which requires adaptations to the abnormal volume and pressure loads. Here, we provide a complete review of RV adaptations as the RV assumes the role of the systemic ventricle, the progression of RV dysfunction to a distinct pattern of heart failure unique to this disease process, and the assessment and management strategies used to protect and rehabilitate the failing RV of Fontan circulation.

Abstract 16135: Higher Body Mass Index in Early Childhood is Associated With Adult Obesity in Patients With a Fontan Circulation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anjali P Chadayammuri ◽  
Tarek ALSAIED ◽  
Adam W Powell ◽  
Samuel G Wittekind ◽  
James Cnota ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Early Childhood ◽  
Body Mass ◽  
Diastolic Pressure ◽  
Fontan Procedure ◽  
Fontan Circulation ◽  
Adult Obesity ◽  
Obese Adults ◽  
Cardiac Testing

Introduction: Obesity is associated with comorbidities that may be detrimental to single-ventricle patients who have had a Fontan procedure. We assessed the prevalence of obesity in adults with a Fontan circulation and evaluated the hypothesis that higher body mass index (BMI) in early childhood is associated with obesity in adulthood. Methods: Retrospective cohort study of patients with a Fontan circulation aged 18-32 years, seen 2011-2019. Those with an atriopulmonary Fontan or chromosomal abnormality known to affect growth were excluded. Historical height and weight measurements, results of recent cardiac testing, and body mass index (BMI) over time were recorded. Obesity was defined as BMI ≥30 kg/m 2 . The associations between childhood anthropometrics, adult BMI, and most recent cardiac testing were assessed. Results: The cohort included 113 adults with a Fontan circulation (median age 22.7 [IQR 20.2-26.4] years; 44% female). There were no significant differences in age, age at Fontan, Fontan type, or ventricular morphology between obese (n=21, 19%; 52% female) and non-obese (n=92, 81%; 41% female) patients. Compared to non-obese adults, obese patients had higher BMI percentiles at age 2 years (80 th [33-95] vs 43 rd [13-82] percentile, p=0.02), at age 4 years (90 th [73-93] vs 57 th [22-81] percentile, p=0.002), and at the time of the Fontan procedure (85 th [51-98] vs 20 th [5-57] percentile, p=0.002). Being overweight at time of Fontan (BMI percentile >85%) strongly predicted later obesity (OR=18.3, 95% CI 3.7-90.3, p<0.001). Obese adults had lower peak VO 2 (19.1±5.2 vs 25.5±6.6 mL/kg/min, p<0.001,) a trend to a lower % predicted VO 2 (59±13 vs 65±14% predicted, p=0.06), higher systolic blood pressure (121±17 vs 112±12 mmHg, p=0.007) and higher ventricular end-diastolic pressure (11±4 vs 9±3 mmHg, p= 0.03). Adult BMI weakly correlated with ventricular end-diastolic pressure (r=0.24, p=0.048). Conclusions: Higher BMI in early childhood is associated with obesity in adults with a Fontan circulation. Adult obesity is associated with worse exercise capacity, higher blood pressure, and higher ventricular end-diastolic pressure. Weight interventions in children with a Fontan circulation may help prevent later obesity and its adverse consequences.

ACCESSMENT OF RIGHT VENTRICULAR SYSTOLIC FUNCTION USING TAPSE

2011 ◽  
pp. 62-70
Author(s):  
Lien Nhut Nguyen ◽  
Anh Vu Nguyen
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Function ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: The prognostic importance of right ventricular (RV) dysfunction has been suggested in patients with systolic heart failure (due to primary or secondary dilated cardiomyopathy - DCM). Tricuspid annular plane systolic excursion (TAPSE) is a simple, feasible, reality, non-invasive measurement by transthoracic echocardiography for evaluating RV systolic function. Objectives: To evaluate TAPSE in patients with primary or secondary DCM who have left ventricular ejection fraction ≤ 40% and to find the relation between TAPSE and LVEF, LVDd, RVDd, RVDd/LVDd, RA size, severity of TR and PAPs. Materials and Methods: 61 patients (36 males, 59%) mean age 58.6 ± 14.4 years old with clinical signs and symtomps of chronic heart failure which caused by primary or secondary DCM and LVEF ≤ 40% and 30 healthy subject (15 males, 50%) mean age 57.1 ± 16.8 were included in this study. All patients and controls were underwent echocardiographic examination by M-mode, two dimentional, convensional Dopler and TAPSE. Results: TAPSE is significant low in patients compare with the controls (13.93±2.78 mm vs 23.57± 1.60mm, p<0.001). TAPSE is linearly positive correlate with echocardiographic left ventricular ejection fraction (r= 0,43; p<0,001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation was found with LVDd and PAPs. Conclusions: 1. Decreased RV systolic function as estimated by TAPSE in patients with systolic heart failure primary and secondary DCM) compare with controls. 2. TAPSE is linearly positive correlate with LVEF (r= 0.43; p<0.001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation is found with LVDd and PAPs. 3. TAPSE should be used routinely as a simple, feasible, reality method of estimating RV function in the patients systolic heart failure DCM (primary and secondary).

scholarly journals Financial Resources and Biomarkers of Aging in the National Health and Aging Trends Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 589-589
Author(s):  
Laura Samuel ◽  
Laken Roberts ◽  
Danielle Boyce ◽  
Melissa Hladek ◽  
Sarah LaFave ◽  
...  
Keyword(s):  
Hemoglobin A1c ◽  
Income Group ◽  
Cross Sectional Study ◽  
Financial Strain ◽  
Diabetes Diagnosis ◽  
Lower Income ◽  
Sampling Weights ◽  
Cross Sectional ◽  
Lower Income Group ◽  
Biomarkers Of Aging

Abstract Lower income and financial strain (i.e. difficulty making ends meet) are associated with worse aging biomarkers, but evidence among nationally representative samples is limited. This cross-sectional study tested whether income to poverty ratio (analyzed separately for those &lt;500% vs. ≥500% poverty threshold) and financial strain are associated with biomarkers of aging among NHATS participants aged ≥65 years (n=4,648), adjusting for age, race/ethnicity, gender, smoking, BMI, and diabetes diagnosis for hemoglobin A1c. Sampling weights were applied. Among those with incomes &lt;500% poverty, higher income was associated with lower hemoglobin A1c (b= -0.0196, p=0.007), CMV (b= -0.0689, p&lt;0.001) and CRP (b= -0.0428, p=0.012). Among those with incomes ≥500%, higher income was associated with lower IL-6 (b= -0.0001, p=0.023) and lower CMV (b= -0.0001, p&lt;0.001). Financial strain was not associated with biomarkers. Income is more strongly associated with biomarkers among the lower income group, calling for special attention to this vulnerable population.

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