Single Ventricular Torsional Mechanics After Fontan Palliation and Their Impact on Outcomes
Authors' conclusion
Single ventricles in a Fontan circulation exhibit abnormal torsional mechanics, which are more pronounced for RV morphology. Abnormal torsion is associated with death or need for heart transplantation.
Study context
- Population
- Fontan patients (15 [IQR: 10–21] years) undergoing MRI
- Participants
- 329 vs 42
- Exposure
- Fontan patients vs controls
- Fontann = 329
- Controlsn = 42reference
- Outcome
- Ventricular rotational mechanics (torsion) and their relationship to death or heart transplant-listing
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Ventricular volume, function and rotational mechanics
EF
Basal clockwise rotation
Apical counterclockwise rotation
Positive torsion
mL/body surface area1.3
| Outcome | Fontan | Controls |
|---|---|---|
| Indexed ventricular end-diastolic volume | 97 | 72 |
- Fontan vs Controls: P < 0.001 — for all
Observational data: associations, not effects.
Further findings
Death or heart transplant-listing (Fontan patients) · median follow-up 3.9 years
- Composite of death or heart transplant-listing occurred in 31 (9%) patients
Death or heart transplant-listing by ventricular morphology and torsion
- Left ventricular (LVs) with negative torsion, and right ventricular (RVs) regardless of torsional pattern, had worse outcomes vs LVs with positive torsion
- P = 0.020
- On multivariate analysis only RV morphology and indexed ventricular end-diastolic volume independently associated
Original publication
Single Ventricular Torsional Mechanics After Fontan Palliation and Their Impact on Outcomes. JACC Adv. Published 7 June 2023. doi:10.
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