{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T21:58:14Z","timestamp":1767909494933,"version":"3.49.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n            <jats:title>Purpose of review<\/jats:title>\n            <jats:p>Patients with a functionally single ventricle (SV) are palliated with a series of procedures leading to a Fontan circulation. Over the life span, a substantial proportion of SV patients develop heart failure that can arise from circulatory or ventricular failure. Diastolic dysfunction (DD) is an important determinant of adverse outcomes in SV patients. However, assessment and categorization of DD in the SV remains elusive. We review recent literature and developments in assessment of DD in the SV and its relation to clinical outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Recent findings<\/jats:title>\n            <jats:p>DD is prevalent in the SV and associated with worse outcomes. Occult DD can be exposed with provocative testing by exercise or preload challenge during catheterization. Likewise, sensitivity to detect DD may be increased via assessment of atrial function and strain imaging. Recent studies revisiting previous concepts such as incoordinate diastolic wall motion show that these are associated with SV end-diastolic pressures and post-Fontan recovery, yielding accessible DD assessment. Emerging technologies such as ultrafast ultrasound (UFUS) can provide noninvasive assessment of myocardial stiffness, inefficient diastolic flow patterns and intraventricular pressure gradients, thereby yielding new tools and insights into diastolic myocardial and hemodynamic properties.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Summary<\/jats:title>\n            <jats:p>Characterizing DD in the SV continues to have substantial limitations, necessitating synthesis of multiple parameters into an overall assessment, accounting for their change over time, and in the context of the patient's clinical status. New and emerging techniques may help advance DD assessment and the ability to track response to treatment of new targets.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/mop.0000000000001385","type":"journal-article","created":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T11:40:20Z","timestamp":1725968420000},"page":"503-511","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Diastolic dysfunction: assessment and implications on the single ventricle circulation"],"prefix":"10.1097","volume":"36","author":[{"given":"Ahmed A.","family":"Hassan","sequence":"first","affiliation":[{"name":"Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Van De Bruaene","sequence":"additional","affiliation":[{"name":"Congenital and Structural Cardiology, Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven, Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark K.","family":"Friedberg","sequence":"additional","affiliation":[{"name":"Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2024,7,24]]},"reference":[{"key":"R1-20250730","doi-asserted-by":"crossref","first-page":"e234","DOI":"10.1161\/CIR.0000000000000696","article-title":"Evaluation and management of the child and adult with Fontan circulation: a scientific statement from the American Heart Association","volume":"140","author":"Rychik","year":"2019","journal-title":"Circulation"},{"key":"R2-20250730","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1136\/heartjnl-2016-310108","article-title":"Factors associated with long-term mortality after Fontan procedures: a systematic review","volume":"103","author":"Alsaied","year":"2017","journal-title":"Heart"},{"key":"R3-20250730","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1136\/hrt.45.3.248","article-title":"Left ventricular fibre architecture in man","volume":"45","author":"Greenbaum","year":"1981","journal-title":"Br Heart J"},{"key":"R4-20250730","doi-asserted-by":"crossref","first-page":"e006738","DOI":"10.1161\/CIRCIMAGING.117.006738","article-title":"Impact of ventricular morphology on fiber stress and strain in Fontan patients","volume":"11","author":"Ghelani","year":"2018","journal-title":"Circ Cardiovasc Imaging"},{"key":"R5-20250730","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s11886-023-01844-3","article-title":"Echo Doppler parameters of diastolic function","volume":"25","author":"Anthony","year":"2023","journal-title":"Curr Cardiol Rep"},{"key":"R6-20250730","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1136\/heart.83.4.420","article-title":"Serial assessment of left ventricular diastolic function after Fontan procedure","volume":"83","author":"Cheung","year":"2000","journal-title":"Heart"},{"key":"R7-20250730","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.echo.2006.11.014","article-title":"The systolic to diastolic duration ratio in children with hypoplastic left heart syndrome: a novel Doppler index of right ventricular function","volume":"20","author":"Friedberg","year":"2007","journal-title":"J Am Soc Echocardiogr"},{"key":"R8-20250730","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.jcmg.2016.03.006","article-title":"Echocardiographic predictors of mortality in adults with a fontan circulation","volume":"10","author":"Cordina","year":"2017","journal-title":"JACC Cardiovasc Imaging"},{"key":"R9-20250730","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1111\/chd.12755","article-title":"Systolic\/diastolic ratio correlates with end diastolic pressures in pediatric patients with single right ventricles","volume":"14","author":"Cua","year":"2019","journal-title":"Congenit Heart Dis"},{"key":"R10-20250730","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.echo.2016.07.016","article-title":"Assessment of diastolic function in single-ventricle patients after the Fontan procedure","volume":"29","author":"Margossian","year":"2016","journal-title":"J Am Soc Echocardiogr"},{"key":"R11-20250730","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1161\/CIRCIMAGING.112.000175","article-title":"Interpretation of left ventricular diastolic dysfunction in children with cardiomyopathy by echocardiography: problems and limitations","volume":"6","author":"Dragulescu","year":"2013","journal-title":"Circ Cardiovasc Imaging"},{"key":"R12-20250730","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1017\/S1047951119001859","article-title":"Comparison of echocardiographic measurements to invasive measurements of diastolic function in infants with single ventricle physiology: a report from the Pediatric Heart Network Infant Single Ventricle Trial","volume":"29","author":"Goudar","year":"2019","journal-title":"Cardiol Young"},{"key":"R13-20250730","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s00246-020-02484-y","article-title":"Atrial reservoir strain is associated with decreased cardiac index and adverse outcomes post Fontan operation","volume":"42","author":"Peck","year":"2021","journal-title":"Pediatr Cardiol"},{"key":"R14-20250730","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1152\/japplphysiol.00295.2022","article-title":"Diastolic myocardial mechanics and their relation to ventricular filling pressures and postoperative course in functionally single ventricles","volume":"135","author":"Yu","journal-title":"J Appl Physiol"},{"key":"R15-20250730","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1007\/s00246-014-0888-4","article-title":"Comparison of pressure-volume loop and echocardiographic measures of diastolic function in patients with a single-ventricle physiology","volume":"35","author":"Chowdhury","year":"2014","journal-title":"Pediatr Cardiol"},{"key":"R16-20250730","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1136\/heartjnl-2015-309042","article-title":"Diagnosis of occult diastolic dysfunction late after the Fontan procedure using a rapid volume expansion technique","volume":"102","author":"Averin","year":"2016","journal-title":"Heart"},{"key":"R17-20250730","doi-asserted-by":"crossref","first-page":"e026508","DOI":"10.1161\/JAHA.122.026508","article-title":"Occult diastolic dysfunction and adverse clinical outcomes in adolescents and young adults with fontan circulation","volume":"12","author":"Peck","year":"2023","journal-title":"J Am Heart Assoc"},{"key":"R18-20250730","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/ejhf.2706","article-title":"Exercise-induced changes in pulmonary artery wedge pressure in adults post-Fontan versus heart failure with preserved ejection fraction and noncardiac dyspnoea","volume":"25","author":"Miranda","year":"2023","journal-title":"Eur J Heart Fail"},{"key":"R19-20250730","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1016\/j.jacc.2019.01.059","article-title":"Left atrial structure and function, and left ventricular diastolic dysfunction: JACC State-of-the-Art Review","volume":"73","author":"Thomas","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"R20-20250730","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1093\/ehjci\/jead087","article-title":"Left atrial stiffness and strain are novel indices of left ventricular diastolic function in children: validation followed by application in multisystem inflammatory syndrome in children due to COVID-19","volume":"24","author":"Zuckerberg","year":"2023","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"R21-20250730","doi-asserted-by":"crossref","first-page":"2651","DOI":"10.1007\/s10554-021-02298-w","article-title":"Atrial function in the Fontan circulation: comparison with invasively assessed systemic ventricular filling pressure","volume":"37","author":"Veldtman","year":"2021","journal-title":"Int J Cardiovasc Imaging"},{"key":"R22-20250730","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1016\/j.jacc.2009.12.036","article-title":"Myocardial fibrosis identified by cardiac magnetic resonance late gadolinium enhancement is associated with adverse ventricular mechanics and ventricular tachycardia late after Fontan operation","volume":"55","author":"Rathod","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"R23-20250730","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.ijcard.2017.04.073","article-title":"Pediatric Fontan patients are at risk for myocardial fibrotic remodeling and dysfunction","volume":"240","author":"Kato","year":"2017","journal-title":"Int J Cardiol"},{"key":"R25-20250730","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.echo.2023.04.021","article-title":"Longitudinal changes in ventricular mechanics in adolescents after the Fontan operation","volume":"36","author":"Aly","year":"2023","journal-title":"J Am Soc Echocardiogr"},{"key":"R27-20250730","doi-asserted-by":"crossref","first-page":"932","DOI":"10.3390\/metabo13080932","article-title":"Comparative metabolomics in single ventricle patients after fontan palliation: a strong case for a targeted metabolic therapy","volume":"13","author":"Renaud","year":"2023","journal-title":"Metabolites"},{"key":"R28-20250730","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1016\/j.jtcvs.2021.06.064","article-title":"Diastolic inflow is associated with inefficient ventricular flow dynamics in Fontan patients","volume":"163","author":"Stone","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"R29-20250730","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1136\/hrt.66.5.375","article-title":"Abnormal patterns of intraventricular flow and diastolic filling after the Fontan operation: Evidence for incoordinate ventricular wall motion","volume":"66","author":"Penny","year":"1991","journal-title":"Br Heart J"},{"key":"R30-20250730","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.echo.2022.01.012","article-title":"Classic-pattern dyssynchrony is associated with outcome in patients with Fontan circulation","volume":"35","author":"R\u00f6sner","year":"2022","journal-title":"J Am Soc Echocardiogr"},{"key":"R31-20250730","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jjcc.2018.07.005","article-title":"Global strain and dyssynchrony of the single ventricle predict adverse cardiac events after the Fontan procedure: analysis using feature-tracking cine magnetic resonance imaging","volume":"73","author":"Ishizaki","year":"2019","journal-title":"J Cardiol"},{"key":"R32-20250730","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/0735-1097(96)00111-8","article-title":"Late ventricular geometry and performance changes of functional single ventricle throughout staged Fontan reconstruction assessed by magnetic resonance imaging","volume":"28","author":"Fogel","year":"1996","journal-title":"J Am Coll Cardiol"},{"key":"R33-20250730","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1161\/01.CIR.92.2.219","article-title":"A study in ventricular\u2013ventricular interaction","volume":"92","author":"Fogel","year":"1995","journal-title":"Circulation"},{"key":"R34-20250730","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1016\/j.echo.2019.06.003","article-title":"Impact of right ventricular geometry and left ventricular hypertrophy on right ventricular mechanics and clinical outcomes in hypoplastic left heart syndrome","volume":"32","author":"R\u00f6sner","year":"2019","journal-title":"J Am Soc Echocardiogr"},{"key":"R36-20250730","doi-asserted-by":"crossref","first-page":"e024095","DOI":"10.1161\/JAHA.121.024095","article-title":"Diastolic dysfunction with preserved ejection fraction after the fontan procedure","volume":"11","author":"Chowdhury","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"R37-20250730","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.ahj.2023.05.010","article-title":"Prevalence and clinical correlates and characteristics of \u201cSuper Fontan\u201d","volume":"263","author":"Ohuchi","year":"2023","journal-title":"Am Heart J"},{"key":"R38-20250730","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1007\/s00246-020-02435-7","article-title":"The influence of atrial strain on functional capacity in patients with the Fontan circulation","volume":"41","author":"Rato","year":"2020","journal-title":"Pediatr Cardiol"},{"key":"R40-20250730","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1111\/chd.12814","article-title":"Echocardiographic assessment of single-ventricle diastolic function and its correlation to short-term outcomes after the Fontan operation","volume":"14","author":"Davis","year":"2019","journal-title":"Congenit Heart Dis"},{"key":"R41-20250730","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.ijcard.2021.09.042","article-title":"Late Fontan failure in adult patients is predominantly associated with deteriorating ventricular function","volume":"344","author":"Sallmon","year":"2021","journal-title":"Int J Cardiol"},{"key":"R42-20250730","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1016\/j.jcmg.2019.09.019","article-title":"Ultrafast ultrasound imaging in pediatric and adult cardiology: techniques, applications, and perspectives","volume":"13","author":"Villemain","year":"2020","journal-title":"JACC Cardiovasc Imaging"}],"container-title":["Current Opinion in Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/MOP.0000000000001385","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T18:00:47Z","timestamp":1753898447000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/MOP.0000000000001385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,24]]},"references-count":38,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.1097\/mop.0000000000001385","relation":{},"ISSN":["1040-8703","1531-698X"],"issn-type":[{"value":"1040-8703","type":"print"},{"value":"1531-698X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,24]]}}}