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The Annals of Thoracic Surgery, Vol 55, 1508-1512, Copyright © 1993 by The Society of Thoracic Surgeons
MA Seliem, JM Baffa, JM Vetter, SL Chen, AJ Chin and WI Norwood Jr
To document and quantitate changes in right ventricular (RV) geometry and
heart rate, we prospectively examined 35 consecutive patients with
hypoplastic left heart syndrome under steady-state conditions (chloral
hydrate sedation) before and after a bidirectional cavopulmonary
anastomosis (hemi-Fontan) procedure. Right ventricular end-diastolic volume
(RVEDV) was calculated as the product of RV cavity areas in two orthogonal
planes divided by RV maximal length in either plane. After the hemi-Fontan
procedure, RVEDV decreased by 33% from 33 +/- 13 to 22 +/- 11 mL (mean +/-
standard deviation). Indexed RVEDV decreased from 86 +/- 37 to 57 +/- 28
mL/m2. The RV wall thickness at the diaphragm in subcostal frontal view
(RVWD) increased by only 11% from 8 +/- 0.2 to 9 +/- 0.2 mm (p = not
significant), but RVWD/RVEDV increased by 111% from 0.36 +/- 0.22 to 0.76
+/- 0.69 mm/mL (p = 0.002). The RV anterior wall thickness in subcostal
sagittal view (RVWA) increased by only 13% from 7 +/- 0.2 to 8 +/- 0.2 mm
(p = not significant), but RVWA/RVEDV increased by 103% from 0.31 +/- 0.20
to 0.63 +/- 0.54 mm/mL (p = 0.002). In 11 of 35 patients (31%), resting
heart rate did not change (118 +/- 14 versus 108 +/- 9 beats/min; p = not
significant); however, in 24 of 35 patients (69%), heart rate increased
significantly (108 +/- 9 versus 127 +/- 10 beats/min; p = 0.05). In
conclusion, RV wall thickness is high before the hemi-Fontan procedure and
increases slightly in the first postoperative week.(ABSTRACT TRUNCATED AT
250 WORDS)
ARTICLES
Changes in right ventricular geometry and heart rate early after hemi- Fontan procedure
Division of Cardiology, Children's Hospital of Philadelphia, PA 19104.
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