Impaired Single Right Ventricular Function Compared to Single Left Ventricles during the Early Stages of Palliation: A Longitudinal Study

2017 
Background Single right ventricles (SRV) are postulated to be disadvantaged compared with single left ventricles (SLV). We compared the evolution of SRV versus SLV function during infancy using conventional measures and speckle-tracking echocardiography (STE). We hypothesized that the SRV is mechanically disadvantaged during early infancy. Methods SRVs ( n  = 32) were compared with SLVs ( n  = 16) at the neonatal (presurgery) and pre-bidirectional cavopulmonary anastomosis (pre-BCPA) stages. Functional measures (fractional area change, indexed ventricular annular plane systolic excursion [iVAPSE], isovolumic acceleration [IVA], myocardial performance index, E and A velocities, tissue Doppler imaging annular velocities and STE-measured global longitudinal and circumferential strain, strain rate [SR], and early diastolic SR [EDSR]) were compared between SRV and SLV at each stage and between presurgery and pre-BCPA. Results Compared with SLV, presurgery SRV had lower circumferential strain (−10.6% vs −16.5%; P  = .0002) and EDSR (1.41%/sec vs 2.13%/sec; P  = .001). Pre-BCPA SRV had decreased IVA (1.2 vs 2.1 m/sec 2 ; P  = .006): longitudinal strain (−15.3% vs −19.1%; P  = .001), SR (−0.97%/sec vs −1.53%/sec; P  = .0001), EDSR (1.5%/sec vs 2.1%/sec; P  = .001); circumferential strain (−10.6% vs −14.9%; P  = .002), SR (−0.8%/sec vs −1.21%/sec; P  = .0001), and EDSR (1.3%/sec vs 1.8%/sec; P  = .009). SRV showed reduction of iVAPSE, IVA, s′, e′, a′ velocities, longitudinal strain, SR, EDSR, and circumferential SR ( P Conclusions The progressive reduction in SRV longitudinal and circumferential function suggests that SRV may have a mechanical disadvantage from birth and progressive impairment with age.
    • Correction
    • Source
    • Cite
    • Save
    • Machine Reading By IdeaReader
    35
    References
    7
    Citations
    NaN
    KQI
    []