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Ann Thorac Surg 1993;55:1508-1512
© 1993 The Society of Thoracic Surgeons

Articles

Changes in right ventricular geometry and heart rate early after hemi-Fontan procedure

Mohamed A. Seliem, MDa,b, Jeanne M. Baffa, MDa,b, Jane M. Vetter, RCVTa,b, Sheng-Liang Chen, MDa,b, Alvin J. Chin, MD*,a,b, William I. Norwood, MD, PhDa,b

a Divisions of Cardiology and Cardiothoracic Surgery, The Children's Hospital of Philadelphia USA
b The Departments of Pediatrics and Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania USA

Accepted for publication September 28, 1992.

* Address reprint requests to Dr Chin, Division of Cardiology, The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104.

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 post-operative week. A concomitant decrease in RVEDV results in a marked change in RV geometry. There is usually a significant increase in resting heart rate as well. Thus, early postoperative chances in RV geometry may have a hemodynamically important impact on stroke volume.




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