Quantitative echocardiographic measures in the assessment of single ventricle function post‐Fontan: Incorporation into routine clinical practice

Rios, Rodrigo; Ginde, Salil; Saudek, David; Loomba, Rohit S.; Stelter, Jessica; Frommelt, Peter C.

doi:10.1111/echo.13408

Cited by 17 publications

(16 citation statements)

References 24 publications

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“…Rios et al. recently confirmed elevated splanchnic resistance that was, as in our study, not significantly different in patients with a single right or left ventricle …”

Section: Discussionsupporting

confidence: 86%

Echocardiographic characteristics in Fontan patients before the onset of protein‐losing enteropathy or plastic bronchitis

et al. 2017

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“…Rios et al. recently confirmed elevated splanchnic resistance that was, as in our study, not significantly different in patients with a single right or left ventricle …”

Section: Discussionsupporting

confidence: 86%

Echocardiographic characteristics in Fontan patients before the onset of protein‐losing enteropathy or plastic bronchitis

et al. 2017

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“…Baseline data collection included underlying cardiac anatomy, details of Fontan repair, New York Heart Association (NYHA) functional status defined as class I -IV [18], resting oxygen saturations, ventricular function defined as good, mild, moderate or severe impairment [19], and Fontan-related complicationssustained cardiac arrhythmias, hepatic dysfunction, thromboembolism, protein-losing enteropathy and plastic bronchitis. Systemic ventricular function was determined by echocardiography using a series of measurements including qualitative assessment, ejection fraction (EF) using single-plane endocardial tracings, M-mode, spectral Doppler and tissue Doppler derived indices for assessment of systemic ventricular function, as described elsewhere [19].…”

Section: Study Design and Patient Populationmentioning

confidence: 99%

“…Systemic ventricular function was determined by echocardiography using a series of measurements including qualitative assessment, ejection fraction (EF) using single-plane endocardial tracings, M-mode, spectral Doppler and tissue Doppler derived indices for assessment of systemic ventricular function, as described elsewhere [19]. Where ejection fraction was calculated, the British Society of Echocardiography grading was used to determine the degree of impairment-normal (EF ≥55%), mild impairment (EF 45-54%), moderate impairment (EF 36-44%) and severe impairment (EF ≤ 35%) [20].…”

Section: Study Design and Patient Populationmentioning

confidence: 99%

Pregnancy outcomes in patients with a fontan circulation and proposal for a risk-scoring system: single centre experience

Arif

Chaudhary

Clift

et al. 2017

J Congenit Heart Dis

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Background: Pregnancy in women with Fontan physiology poses a significant management challenge and is deemed high risk. The aim of this study is to describe short and long-term pregnancy outcomes in women who have undergone Fontan palliation and propose a novel risk-stratification model specific to women with a Fontan heart. Methods: We undertook a single-centre, retrospective cohort study of all female Fontan patients (n = 78) from 1991-2015. We recorded pregnancy outcome, maternal cardiovascular and obstetric complications and fetal outcome. We propose a risk stratification model to identify those women who might be at highest risk of adverse outcomes during pregnancy. Results: Twenty-one women had 55 pregnancies, with 13 (24%) live births and 38 (69%) spontaneous miscarriages (p < 0.001). Eight (62%) out of 13 live birth pregnancies incurred maternal cardiovascular complications and six (46%) experienced maternal obstetric complications. Median gestational age at delivery was 32(27-39) weeks with 12 out of 13 (92%) pregnancies resulting in pre-term delivery. There were more pregnancies (OR 4.90, 95% CI 1.46-16.42, p ≤ 0.01) and a trend towards a higher proportion of live births (OR 7.60, 95% CI 1.81-31.97, p = 0.06), in the 'lower risk' compared to those women in the 'very high risk' group. There were no maternal deaths. Conclusions: We observed a high first trimester miscarriage rate, significant maternal cardiovascular and obstetric complication rates and a high rate of pre-term births in pregnant Fontan women. Our risk stratification model requires further investigation but may identify those women at particularly high risk of a poor outcome, and inform realistic pre-pregnancy counselling.

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“…Traditional two‐dimensional echocardiographic assessments rely on qualitative observations of systolic wall shortening, which can have a significant interobserver variability, and do not correlate with postoperative Fontan outcomes . Recent studies have evaluated the utility of echocardiographically derived myocardial deformation imaging in this population as a more sensitive and quantitative measure of myocardial function . Diastolic strain and strain rate correlate with ventricular filling pressures and clinic outcomes in patients with structurally normal heart and may better predict postoperative outcomes in patients undergoing the Fontan operation.…”

Section: Introductionmentioning

confidence: 99%

“…3 Recent studies have evaluated the utility of echocardiographically derived myocardial deformation imaging in this population as a more sensitive and quantitative measure of myocardial function. 6 Diastolic strain and strain rate correlate with ventricular filling pressures and clinic outcomes in patients with structurally normal heart 7-9 and may better predict postoperative outcomes in patients undergoing the Fontan operation.…”

mentioning

confidence: 99%

Echocardiographic assessment of single‐ventricle diastolic function and its correlation to short‐term outcomes after the Fontan operation

Davis

Ginde

Stelter

et al. 2019

Congenital Heart Disease

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Background/Hypothesis/Objectives Postoperative complications after the Fontan operation for single ventricle heart disease are common and include persistent pleural drainage and prolonged length of hospital stay (LOS). Diastolic ventricular dysfunction may increase risk for postoperative complications by raising central venous pressures. We sought to determine the relationship between preoperative echocardiographic measurements of diastolic function, including myocardial deformation imaging, on (a) preoperative invasive catheterization measurements and (b) postoperative outcomes after the Fontan procedure. Design/Methods All patients that underwent Fontan procedure from 2011 to 2017 were included. Echocardiograms performed within 6 months prior to Fontan operation were evaluated. Measurements of ventricular global and diastolic strain and strain rate were performed offline with TomTec speckle tracking software. Other diastolic function measurements included atrioventricular valve inflow and annular tissue Doppler imaging. Diastolic function measurements were correlated with pre‐Fontan catheterization measurements and postoperative Fontan outcomes using Spearman’s rho. Multivariable logistic regression for a prolonged LOS (>75%ile for postoperative LOS) was performed to adjust for preoperative risk factors. Results A total of 141 patients were included in the study. Majority had single morphologic right ventricle (58.9%). Median age at time of Fontan was 3.4 years (IQR 2.9‐4). Median hospital LOS was 9 days (IQR 7‐11). Circumferential diastolic strain rate weakly correlated with LOS (rho = −0.21, P = .01). There was no correlation between any other diastolic strain measurements and pre‐Fontan end‐diastolic pressure or postoperative LOS. In multivariable analysis, E/E′ was the only echo measurement that predicted prolonged hospital LOS (OR 1.4, 95%CI: 1.1‐1.8, P = .003). Conclusion Preoperative diastolic strain measurements did not have a strong association with postoperative Fontan outcomes. Increased E/E′ ratio, however, did predict greater LOS after Fontan procedure, and may be useful in preoperative risk stratification. Future studies are needed to further assess the utility of diastolic strain imaging in the single‐ventricle population.

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Quantitative echocardiographic measures in the assessment of single ventricle function post‐Fontan: Incorporation into routine clinical practice

Abstract: Advanced quantitative assessment of SV function post-Fontan can be consistently and efficiently performed real time during clinically indicated echocardiograms with excellent reliability.

Cited by 17 publications

References 24 publications

Echocardiographic characteristics in Fontan patients before the onset of protein‐losing enteropathy or plastic bronchitis

Echocardiographic characteristics in Fontan patients before the onset of protein‐losing enteropathy or plastic bronchitis

Pregnancy outcomes in patients with a fontan circulation and proposal for a risk-scoring system: single centre experience

Echocardiographic assessment of single‐ventricle diastolic function and its correlation to short‐term outcomes after the Fontan operation

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