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Great Ormond Street
Hospital for Children NHS Trust and Institute of Child Health,
University of London WC1N 3JH, UK
Correspondence to: Professor Redington email: reding{at}ibm.net
Accepted 6 January 2000
OBJECTIVE
To assess longitudinal
changes in systemic ventricular diastolic function late after the
Fontan procedure.
DESIGN AND PATIENTSProspective study
of 13 patients at 2.8 (2.0) years (early) and again at 11.4 (2.0) years
(late) after the Fontan procedure by Doppler echocardiography with
simultaneous ECG, phonocardiogram, and respirometer.
SETTINGTertiary paediatric cardiac centre.
RESULTSThe isovolumic relaxation
time (IVRT) was significantly longer, and E wave deceleration time, E
and A wave velocities, and E:A velocity ratio were reduced compared to
normal both early and late after the procedure. The mean (SD) z score
of IVRT decreased significantly from +2.50 (1.00) to +1.24 (0.80)
(p = 0.002), and the z score of the E wave deceleration time
decreased from 
1.69 (1.31) to 2.40 (1.47) (p = 0.03) during
follow up. The A wave deceleration time also tended to decrease (early
80 (12) ms v late 73 (11) ms, p = 0.13)
with increased follow up. There were no changes of the E and A wave
velocities and E:A velocity ratio. The E wave velocity was inversely
related to IVRT both early (r = 0.82,
p = 0.001) and late (r = 0.59,
p = 0.034) after the operation. The prevalence of diastolic flow
during isovolumic relaxation decreased from 85% (11/13) to 38% (5/13)
(p = 0.04), while that of mid diastolic flow increased from 23%
(3/13) to 77% (10/13) (p = 0.02) between the two assessments.
CONCLUSIONSLeft ventricular
diastolic function remains highly abnormal late after the Fontan
procedure. The longitudinal changes demonstrated on follow up are
compatible with reduction of left ventricular compliance in addition to
persisting abnormalities of relaxation.
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