The impact of ventricular morphology on wall stress and ventricular strain in Fontan patients
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KeywordsRight Ventricular Cardiac Magnetic Resonance Fontan Patient Global Circumferential Strain Ventricular Morphology
Adverse outcomes are increasingly common in patients after the Fontan operation as they approach adulthood. Right ventricular (RV) morphology, ventricular dilation, and diminished ventricular strain have all been independently associated with death or heart transplant. The aim of this study was to assess the impact of ventricular morphology on ventricular stress/strain relationship in patients late after the Fontan operation using cardiac magnetic resonance (CMR).
Clinical CMR studies in patients with Fontan circulation between January 1, 2005 and June 30, 2013 were retrospectively analyzed. Ventricular mass and volumes were calculated using commercially available software (QMass, Medis Medical Imaging Systems, Leiden, the Netherlands). Global circumferential strain (GCS) was measured for the single or dominant ventricle at the mid ventricular level using commercial software (2D CPA MR, TomTec imaging systems, Unterschleissheim, Germany). End systolic wall stress (WS) was calculated for the ventricle using a thick-walled sphere model. Arm cuff mean arterial blood pressure was used as a surrogate for left ventricular end-systolic pressure.
Compared to Fontan patients with a functional single LV, those with a dominant RV have an adverse stress-strain relationship. Inadequate ventricular hypertrophy is the primary driver for higher WS in single RVs. This may, in part, explain the previously reported unfavorable outcomes in Fontan patients with RV morphology as compared to LV morphology.
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