Um sistema de ventrículo pulmonar produzindo pressão pulsátil em único ventrículo: modelo experimental

Emrecan, Bilgein; Kestelli, Mert; Yilik, Levent; Lafci, Banu; Özsöyler, İbrahim; Gürbüz, Ali; Özbek, Cengiz

doi:10.1590/s0102-76382006000300012

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…We suggest that in the single ventricle, the volume and diameter calculations must include rudimentary ventricle due to the Laplace rule as explained above [15]. In case rudimentary ventricle is not included, the contractility measurements such as ejection fraction of the main ventricle, fractional shortening of the lone systemic ventricle and only velocity circumferential meridional shortening would be incorrect.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Contractility for Fontan Connections

Kestelli¹,

Bozok²

2014

WJCS

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This study is performed to investigate the effect of Fontan operations on cardiac contractility. Investigation of articles about the contractility in Fontan published in PubMed up to now revealed that the measurement of contractility values did not include the rudimentary ventricle. Connections between right atrium and right ventricle as well as right atrium and pulmonary artery were studied in the same group as well. In our opinion, for the single ventricular physiology, the RA-RV and RA-PA connected patients' preload and afterload values cannot be calculated in the same group since volume of rudimentary ventricles must be considered from this point of view as well.

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Section: Discussionmentioning

confidence: 99%

Assessment of Contractility for Fontan Connections

Kestelli¹,

Bozok²

2014

WJCS

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Why Fontan procedure fails in the long term

Kestelli

Yurekli

Şahin

et al. 2009

European Journal of Cardio-Thoracic Surgery

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We appreciate the letter by Dr Botta and colleagues [1] with regard to our article 'Treatment of complex disease of the thoracic aorta: The frozen elephant trunk technique with the E-vita open prosthesis' [2].Our experience with the frozen elephant trunk (FET) technique was initiated in January 2007, and, since then, we have treated more than 50 patients. Based on these very encouraging results, we are widening the scope of indications to even more complex cases. Currently, our indications can be summarised as follows: chronic and acute dissections diffusely involving the thoracic aorta, chronic aneurysms of the ascending arch and descending aorta and aneurysms of the distal part of the aortic arch. In case of acute type A aortic dissection, we use the FET when the arch requires repair because of a rupture or dilatation.Since our increasing experience with the FET, our use of the classical elephant trunk (ET) technique is on the decline: this technique always requires a second surgical or endovascular step, which can be avoided with FET. We agree with Dr Botta that FET can sometimes be incomplete and some patients could require a further distal aortic repair, but we do not think this operation can be considered unfavourable when compared with the classical ET. However, larger number of patients and longer follow-up are necessary for definitive conclusions.Regarding the e-vita delivery, we always verify the correct opening of the stent with a Hegar dilator. Fluoroscopy and balloon remodelling could be helpful; however, in these patients who have undergone long periods of visceral ischaemia and extracorporeal circulation, the use of the contrast medium can result in a severe impairment of the renal function.We find trans-oesophageal echocardiography to be very useful. It provides important information about stent expansion and aneurysm exclusion.With regard to the myocardial protection, we have good experience with Custodiol cardioplegia: a single dose of 20-25 ml kg À1 guarantees 3 h of myocardial ischaemia. In exceptional cases of myocardial ischaemia longer than 3 h, half dose of Custodiol can be repeated.Regarding neurological complications, all patients who suffered from spinal cord injury developed early symptoms detectable during awakening from anaesthesia. We totally agree with the comments by Dr Botta and colleagues on the aetiopathogenesis of spinal cord ischaemia (SCI): the mechanism underlying the occurrence of SCI is yet to be completely understood. The patient who suffered from paraplegia had an associated vertebral angioma at the T5 level and a magnetic resonance imaging (MRI) performed during the postoperative period showed some anomalies of the spinal cord vascularisation: Could these anomalies have played a role on the spinal cord injury?Prior abdominal aortic aneurysm repair was an important risk factor for spinal cord ischaemia in our experience as well; however, none of our patients had undergone previous abdominal aortic repair. References[1] Botta L, Cannata A, Martinelli L. The E-vita pros...

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Reply to Kestelli et al. Long-term ramifications of Fontan circulation

Mavroudis¹,

Backer²,

Deal³

2009

European Journal of Cardio-Thoracic Surgery

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4. The diameter and the wall thickness of the rudimentary ventricle were not taken into account while deriving measurements from Laplace's rule. This is not compatible with the laws of physics. After correction of the aforementioned measurements incompatible with cardiac physiology, we think that the real cause of the unwanted results of Fontan procedure could be understood.Our opinion is that this is caused by a lack of volume, which could be corrected by systems that create pulsatile pressures, applicable to human beings.

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Um sistema de ventrículo pulmonar produzindo pressão pulsátil em único ventrículo: modelo experimental

Abstract: Um sistema de ventrículo pulmonar produzindo pressão pulsátil em único ventrículo: modelo experimental

Cited by 3 publications

References 5 publications

Assessment of Contractility for Fontan Connections

Assessment of Contractility for Fontan Connections

Why Fontan procedure fails in the long term

Reply to Kestelli et al. Long-term ramifications of Fontan circulation

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