Previous studies have demonstrated that regional wall motion abnormalities are common in univentricular hearts; however, the mechanism of this abnormality and its relation to hemodynamics remain unclear. The aim of this study was to document and analyze the etiology of regional wall motion abnormality and its relation to hemodynamics in univentricular hearts. Sixteen patients (age 11+/-6 years) were examined. A tagged cine magnetic resonance imaging method that superimposes "tags" on myocardium was used to assess regional systolic motion. The tags were traced from end-diastole to end-systole, and the percent regional shortening fraction was calculated as the shortening ratio. The tags were positioned on 6 segments. Normal ranges for wall motion were established from 10 normal volunteers. An asynchrony index was calculated as the SD divided by the mean regional shortening fraction to quantify asynchronous regional motion. Hemodynamic parameters were also obtained by cardiac catheterization. In patients, regional shortening fraction was significantly lower in segments adjacent to the rudimentary chamber compared with normal values in both circumferential and longitudinal directions (p <0.05 and p <0.01, respectively). The asynchrony index was much greater in patients than in controls (62+/-25 vs 27+/-10, p <0.01). The index correlated with rudimentary chamber volume and the rudimentary/main chamber volume ratio (r = 0.58, r = 0.79, respectively). Furthermore, the index correlated with end-diastolic pressure (r = 0.82). The rudimentary chamber may play an important role in causing asynchronous regional motion, and this motion may contribute to ventricular diastolic dysfunction.