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Evidence of impaired longitudinal strain in pre-Fontan palliation in functional single left ventricle

Del Pasqua, Alessiaa; Chinali, Marcelloa; D’Anna, Carolinaa; Ciliberti, Paoloa; Esposito, Claudiaa; Gugliotta, Mariaa; Milewski, Priscillaa; Perrone, Marco Alfonsoa,b; Romeo, Francescob; Carotti, Adrianoa; Guccione, Paoloa; Rinelli, Gabrielea

Journal of Cardiovascular Medicine: December 2019 - Volume 20 - Issue 12 - p 833–836
doi: 10.2459/JCM.0000000000000887
Research articles: Congenital heart disease

Background We evaluated two-dimensional speckle-tracking echocardiography longitudinal strain (L2DSE) in functionally single left ventricles (LV).

Methods We retrospectively analyzed 21 patients with functionally single LV. We divided patients into two groups according to pre-Fontan cardiac catheterization data: group 1, adequate data for Fontan procedure and group 2, inadequate data.

Results LV strain correlated with predicted pressure in the Fontan system (r = 0.64; P = 0.003), pressure in the Glenn system (r = 0.57; P = 0.010), and transpulmonary gradient (r = 0.59; P = 0.008), but not with left atrial pressure (r = 0.292; P = 0.226) or ejection fraction (r = 0.254; P = 0.294). In multiple regression analysis, four-chamber LV strain was correlated with predicted pressure in the Fontan (β = 0.642: P = 0.003), whereas no association was found with LV ejection fraction (β = 0.254; P = 0.294), or time from Glenn palliation (β = 0.082; P = 0.893). When dividing the population into two groups according to catheterization data, significantly lower four-chamber longitudinal 2DSE (−25.8 ± 3.2 vs.−19.5 ± 5.1; P = 0.004) was found to be not suitable for the Fontan procedure, as compared with those who underwent successful Fontan completion.

Conclusion Regardless of ejection fraction, four-chamber L2DSE is associated with high predicted pressure in the Fontan system. Patients with hemodynamic data unsuitable for Fontan operation have significantly lower mean longitudinal strain parameters. 2DSE may represent a valuable tool in assessing patients with single LV physiology and might provide useful pre-Fontan information.

aPediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCSS

bDivision of Cardiology, University of Rome Tor Vergata, Rome, Italy

Correspondence to Alessia Del Pasqua, MD, Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCSS, Piazza Sant’Onofrio, 4, 00165 Rome, Italy Tel: +39 668593263; fax: +39 668592838; e-mail:

Received 23 March, 2019

Revised 5 September, 2019

Accepted 21 September, 2019

© 2019 Italian Federation of Cardiology. All rights reserved.