Insights into the Evolution of Myocardial Dysfunction in the Functionally Single Right Ventricle between Staged Palliations Using Speckle-Tracking Echocardiography

Background The long-term prognosis of hypoplastic left heart syndrome is limited by progressive right ventricular dysfunction. The aim of this study was to determine the trends in single right ventricular systolic function between staged palliative surgeries using speckle-tracking and conventional echocardiography. Methods There were 76 patients with functionally single right ventricles at the (1) pre-Norwood ( n = 26), (2) pre–bidirectional cavopulmonary anastomosis (BCPA; n = 19), (3) pre-Fontan ( n = 16), and (4) post-Fontan ( n = 15) stages, compared with 30 controls of similar ages. Speckle-tracking-derived longitudinal and circumferential strain and strain rate, postsystolic strain index, and mechanical dyssynchrony index were compared with conventional measures of ventricular function. Differences between stages were analyzed using analysis of variance ( P < .05). Results Strain rate was highest at the pre-Norwood stage and decreased at the other stages (longitudinal P