S S M Bossers1, L Kapusta2, I M Kuipers3, G van Iperen4, A Moelker5, L J M Kroft6, S Romeih7, Y de Rijke8, A D J Ten Harkel9, W A Helbing10. 1. Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. 2. Department of Pediatric Cardiology, Radboud University Medical Centre - Amalia Children's Hospital, Nijmegen, The Netherlands,; Department of Pediatrics, Pediatric Cardiology Unit, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. 3. Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands. 4. Department of Pediatric Cardiology, University Medical Center Utrecht - Wilhelmina Children's Hospital, Utrecht, The Netherlands. 5. Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. 6. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. 7. Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. 8. Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, The Netherlands. 9. Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands. 10. Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: w.a.helbing@erasmusmc.nl.
Abstract
BACKGROUND/ OBJECTIVE: Total cavopulmonary connection (TCPC) has been the preferred treatment for patients with univentricular hearts. Current TCPC-techniques are the intra-atrial lateral tunnel (ILT) and the extracardiac conduit (ECC). We aimed to determine ventricular function during rest and stress, and to compare results for both techniques and for left (LV) versus right ventricular (RV) dominance. METHODS: 99 patients, aged 12.5 ± 4.0 years underwent echocardiography and magnetic resonance imaging (MRI), and 69 patients underwent stress MRI. RESULTS: Echocardiography showed impaired systolic and diastolic function. MRI parameters were comparable between ILT and ECC at rest. During dobutamine there was a decrease in end-diastolic volume (EDVi) (91 ± 21 vs. 80 ± 20 ml/m(2) p<0.001). Ejection fraction (EF) and cardiac index (CI) during dobutamine were lower for ILT patients (59 ± 11 (ILT) vs. 64 ± 7% (ECC), p=0.027 and 4.2 ± 1.0 (ILT) vs. 4.9 ± 1.0L/min/m(2) (ECC), p=0.006), whereas other parameters were comparable. TEI-index was higher in ILT-patients (0.72 ± 0.27 (ILT) vs. 0.56 ± 0.22 (ECC), p=0.002). Diastolic function was frequently impaired in patients with a dominant RV (67% (RV) vs. 39% (LV), p=0.011). Patients with dominant LV's had smaller end-systolic volume (ESVi) (40 ± 13 (LV) vs. 47 ± 16 (RV) ml/m(2), p=0.030) and higher EF (55 ± 8 (LV) vs. 49 ± 9 ml/m(2) (RV), p=0.001) and contractility (2.3 ± 0.8 (LV) vs. 1.9 ± 0.7 mmHg/ml/m(2) (RV), p=0.050) during rest and higher EF during dobutamine (63 ± 8 (LV) vs. 58 ± 10 ml/m(2) (RV), p=0.043). CONCLUSION: Ventricular function is relatively well preserved in modern-day Fontan patients. With dobutamine stress there is a decrease in EDVi. ECC patients have higher CI and EF during stress. Patients with a dominant RV have lower systolic, including impaired contractility, and diastolic function.
BACKGROUND/ OBJECTIVE: Total cavopulmonary connection (TCPC) has been the preferred treatment for patients with univentricular hearts. Current TCPC-techniques are the intra-atrial lateral tunnel (ILT) and the extracardiac conduit (ECC). We aimed to determine ventricular function during rest and stress, and to compare results for both techniques and for left (LV) versus right ventricular (RV) dominance. METHODS: 99 patients, aged 12.5 ± 4.0 years underwent echocardiography and magnetic resonance imaging (MRI), and 69 patients underwent stress MRI. RESULTS: Echocardiography showed impaired systolic and diastolic function. MRI parameters were comparable between ILT and ECC at rest. During dobutamine there was a decrease in end-diastolic volume (EDVi) (91 ± 21 vs. 80 ± 20 ml/m(2) p<0.001). Ejection fraction (EF) and cardiac index (CI) during dobutamine were lower for ILT patients (59 ± 11 (ILT) vs. 64 ± 7% (ECC), p=0.027 and 4.2 ± 1.0 (ILT) vs. 4.9 ± 1.0L/min/m(2) (ECC), p=0.006), whereas other parameters were comparable. TEI-index was higher in ILT-patients (0.72 ± 0.27 (ILT) vs. 0.56 ± 0.22 (ECC), p=0.002). Diastolic function was frequently impaired in patients with a dominant RV (67% (RV) vs. 39% (LV), p=0.011). Patients with dominant LV's had smaller end-systolic volume (ESVi) (40 ± 13 (LV) vs. 47 ± 16 (RV) ml/m(2), p=0.030) and higher EF (55 ± 8 (LV) vs. 49 ± 9 ml/m(2) (RV), p=0.001) and contractility (2.3 ± 0.8 (LV) vs. 1.9 ± 0.7 mmHg/ml/m(2) (RV), p=0.050) during rest and higher EF during dobutamine (63 ± 8 (LV) vs. 58 ± 10 ml/m(2) (RV), p=0.043). CONCLUSION: Ventricular function is relatively well preserved in modern-day Fontan patients. With dobutamine stress there is a decrease in EDVi. ECC patients have higher CI and EF during stress. Patients with a dominant RV have lower systolic, including impaired contractility, and diastolic function.
Authors: Vivian P Kamphuis; Mohammed S M Elbaz; Pieter J van den Boogaard; Lucia J M Kroft; Hildo J Lamb; Mark G Hazekamp; Monique R M Jongbloed; Nico A Blom; Willem A Helbing; Arno A W Roest; Jos J M Westenberg Journal: J Cardiovasc Magn Reson Date: 2019-07-25 Impact factor: 5.364
Authors: Jelle P G van der Ven; Sjoerd S M Bossers; Eva van den Bosch; Niels Dam; Irene M Kuipers; Gabrielle G van Iperen; Lucia J M Kroft; Livia Kapusta; Arend D J Ten Harkel; Willem A Helbing Journal: Open Heart Date: 2021-03
Authors: Eva van den Bosch; Sjoerd S M Bossers; Vivian P Kamphuis; Eric Boersma; Jolien W Roos-Hesselink; Johannes M P J Breur; Arend D J Ten Harkel; Livia Kapusta; Beatrijs Bartelds; Arno A W Roest; Irene M Kuipers; Nico A Blom; Laurens P Koopman; Willem A Helbing Journal: J Am Heart Assoc Date: 2021-02-24 Impact factor: 5.501
Authors: L P Koopman; L M Geerdink; S S M Bossers; N Duppen; I M Kuipers; A D Ten Harkel; G van Iperen; G Weijers; C de Korte; W A Helbing; L Kapusta Journal: Pediatr Cardiol Date: 2017-10-25 Impact factor: 1.655