Vol. 26 No. 2 (2022)
CONGENITAL HEART DISEASES

The choice of echocardiographic parameters for determining the hemodynamics phenotype in children after Fontan procedure

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  • Yu.S. Sinelnikov,
  • E.N. Orekhova,
  • S.A. Orekhov,
  • T.V. Matanovskaya
Yu.S. Sinelnikov
Sukhanov Federal Center of Cardiovascular Surgery, Perm; Vagner Perm State Medical University, Perm
E.N. Orekhova
Sukhanov Federal Center of Cardiovascular Surgery, Perm; Vagner Perm State Medical University, Perm
S.A. Orekhov
Sukhanov Federal Center of Cardiovascular Surgery, Perm
T.V. Matanovskaya
Sukhanov Federal Center of Cardiovascular Surgery, Perm
Bio
Кластеризация эхокардиографических параметров
DOI: https://doi.org/10.21688/1681-3472-2022-2-38-48

Published 2022-06-30

Keywords

  • echocardiography,
  • Fontan procedure,
  • heart failure,
  • hemodynamics,
  • pro-brain natriuretic peptide

How to Cite

Sinelnikov, Y., Orekhova, E., Orekhov, S., & Matanovskaya, T. (2022). The choice of echocardiographic parameters for determining the hemodynamics phenotype in children after Fontan procedure. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 26(2), 38–48. https://doi.org/10.21688/1681-3472-2022-2-38-48

Copyright (c) 2022 Sinelnikov Yu.S., Orekhova E.N., Orekhov S.A., Matanovskaya T.V.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim. Evaluation of echocardiographic parameters to characterize the hemodynamics phenotype in children after Fontan procedure.
Methods. 30 children aged 8.06 ± 4.3 years, body surface area 0.95 ± 0.33 m2, 12 boys (40%) with a functionally single ventricle after total cavopulmonary connection with extracardiac conduit fenestration. In addition to traditional echocardiographic parameters we assessed: systemic ventricular preload (stroke volume index, SVI), ventricular afterload (arterial elastance), arterial compliance, end–systolic ventricular elastance (VE), ventricular–arterial coupling (VAC), transpulmonary gradient (TPG).
Results. In 33.3% (n = 10) children, the parameters of the single ventricle function were comparable to the normative values in biventricular hemodynamics. In 3 (10%) patients decreased values of the single ventricle systolic function were found (ejection fraction 40.0 ± 3.5%, fraction area changes 44.6 ± 3.5%, longitudinal strain −4.03 ± 0.87%), preload (SVI 13.30 ± 0.64 ml/m2), arterial compliance, (0.47 ± 0.17 ml/mm Hg), increased VAC (1.81 ± 0.10). In 36.6% of children (n = 11), a decrease in preload was found (SVI 27.4 ± 1.2 ml/m2), an increase in ventricular-arterial coupling (2.17 ± 0.16), and a decrease VE (1.98 ± 0.45 mm Hg/ml), an increase E/e´ (13.2 ± 1.7). In 20% of cases (n = 6) an increase in TPG was determined (11.6 ± 0.9 mm Hg).
Conclusion. In children after Fontan procedure, 4 hemodynamic phenotypes were revealed in accordance with echocardiographic parameters: compensated, hypocontractile, with impaired diastolic properties of the systemic ventricle and with increased pulmonary vascular resistance. With a hypocontractile phenotype of hemodynamics, a significantly increased concentration of the pro-brain natriuretic peptide is determined. The phenotype of hemodynamics with increased pulmonary vascular resistance is more often associated with a higher functional class of heart failure.

Received 10 September 2021. Revised 4 October 2022. Accepted 14 December 2022.

Funding: The study did not have sponsorship.

Conflict of interest: Authors declare no conflict of interest.

Contribution of the authors: The authors contributed equally to this article.

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