Darii O. IY., Yurpolskaya L.A., Yurlov I.A., Dorofeev A.V.



Еvaluation of the myocardial geometry and morphology of single ventricle (SV) patients using imaging methods allows confirming the ventricular dysfunction. The resulting afterload causes ventricular hypertrophy that can impair diastolic ventricular performance after Fontan operation, and subaortic muscular obstruction may follow.

Purpose. To show the geometry modifications and outflow tract obstruction predictors at 16-year-old man with SV after multi-stage palliation (3rd stage the Fontan procedure) long-term follow up, complained of a worsening of his state, decrease stress tolerance, dyspnea and heart rhythm disturbances.

Material and methods. Echocardiography showed SV myocardial contractility decrease, increased trabecularity in the cavity, aneurysm of the superior vena cava (SVC), subaortic obstruction is questionable, a gradient of 15 mmHg. CMR data confirmed a SVC aneurysm, evidence of SV myocardium hypertrophy (the anterior wall in diastole was 15 mm), atypical structure and attachment of the papillary muscles with signs of aortic outflow obstruction, increase in trabecularity with myocardial disorganization and the deep lacunae formation, which indicate the progression of SV dysfunction in the late long-term postoperative period.

Conclusion. The success of a multistage palliative therapy strategy for patients with SV depends on the presence of favorable anatomical and hemodynamic criteria. Multi-modality imaging methods identify patients who are at risk of developing obstructive systemic ventricular outflow tract, for accurate planning of surgical treatment, which will affect the long-term results.

A.N. Bakulev National Medical Research Center of Cardiovascular Surgery.

Keywords: single ventricle, Fontan operation, aortic outflow obstruction, non-compact myocardium, CMR.

Corresponding author:  Darii O. IY., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript


For citation: Darii O. IY., Yurpolskaya L.A., Yurlov I.A., Dorofeev A.V. Changes in single ventricular geometry and morphology after fontan operation. REJR 2022; 12(2):164-171. DOI: 10.21569/2222-7415-2022-12-2-164-171.

Received:        11.03.22 Accepted:       17.05.22