Dynamics of right heart flow in patients after Fontan procedure

Abstract

In seven patients who underwent Fontan procedures but in whom no valves were inserted, dynamics of right heart flow were evaluated with the use of a catheter-tipped velocity transducer, pulsed Doppler echocardiography, and angiocardiography. Right atrial (RA) contraction caused a forward flow to the pulmonary artery (PA) and a backward flow to the inferior vena cava (IVC). Backward flow to the superior vena cava (SVC) was minimal. As the right atrium relaxed, a rapid forward flow occurred at the IVC and SVC that filled the atrium and a small amount of pulmonary regurgitant flow was observed. Subsequently, a forward flow was observed at the IVC, SVC, and PA during RA diastole. Angiographically determined RA stroke volume (SV) was less than 40% of the left ventricular (LV) SV in three patients in whom the postoperative increase in atrial "a" wave pressure (delta p) was greater than 8 mm Hg, while it was similar to or greater than LVSV in four patients in whom delta p was 6 mm Hg or less. In all patients LV end-diastolic volume was 107 +/- 27(SD)% of normal but LV ejection fraction was 0.53 +/- 0.07, resulting in the reduced cardiac output (2.8 +/- 0.7 l/min/m2). There was no correlation between the RASV or RA ejection fraction and cardiac output. These data show that the RA contraction causes a forward flow to the PA and that pulmonary regurgitation is not significant after Fontan procedure even when valves are not inserted. Also, the postoperative increase in the RA afterload may depress RA function.(ABSTRACT TRUNCATED AT 250 WORDS)