Abstract
Background. Currently extracardiaс Fontan procedure is the method of choice in patients with univentricular
hearts. However, there is assumption of a graduale deterioration of the functional status of the myocardium
in the period after such surgery. Nevertheless, there is need to evaluate clinical and functional myocardial
reserve status of patients in the follow-up period.
Material and methods. We evaluated 20 patients in a period ranging from 2-15 years post extracardiac Fontan
procedure. The mean age of patients was 23+6.0 years. Stress tests with treadmill was used to assess toleance
of physical strain, while stress-echo and tissue Doppler imaging for systolic and diastolic functions. We analyzed
increment of EF, systolic (S), diastolic (early E and late A) myocardial annulus velocities and E\A ratio
after physical strain. Also statistical analysis of risk factors leading to declining myocardial reserves in these
patients.
Results. The value of METs during peak load was in the diapason of 4.6-10.1 (mean 7.7+2.2). Ejection fraction
of univentricular heart was mean 53.5+3.3 % (50-60%) in rest and mean 54.9+4.2% (47-66%) after
stress (p=0,37). Research of systolic velocities showed 7.2+1.6 sm/sec in rest and 8.1+1.7 sm/sec after strain
at right ventricle free wall (р=0.192), 8.4+1.2 sm/sec in rest and 9.6+1.4 sm/sec after stress (р=0.030) at left
ventricle lateral wall. E/A analysis showed the presence of myocardial diastolic dysfunction type I in 60% of
patients at rest, but worsening of diastolic function was observed in all after stress test.
Conclusions. In a long-term period, most patients showed decreased systolic reserve and diastolic dysfunction
of myocardium even when there is good reaction during stress test. Major risk factors for decreased
myocardial reserves are diastolic dysfunction, significant atrioventricular valve regurgitation morphologically
right functionale single ventricle and also long-term post-operation complications which lead to progressive
circulation failure.
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