Cardiac Rest and Reserve Function in Patients With Fontan Circulation

Senzaki, Hideaki; Masutani, Satoshi; Ishido, Hirotaka; Taketazu, Mio; Kobayashi, Toshiki; Sasaki, Nozomu; Asano, Haruhiko; Kobayashi, Toshiyuki; Kyo, Shunei; Yokote, Yuji

doi:10.1016/j.jacc.2006.03.022

Cited by 152 publications

(110 citation statements)

References 40 publications

(45 reference statements)

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“…There was no difference in BNP between male and female patients (14 [IQR 6-33] vs. 13 [IQR 7-25] pg/ml), nor between patients with left or right ventricular morphology (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) vs. 14 [IQR 7-41] pg/ml).…”

Section: Resultsmentioning

confidence: 99%

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B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

Koch

Zink

Singer

et al. 2008

European J of Heart Fail

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Aims: To assess plasma B-type natriuretic peptide (BNP) levels in patients with univentricular hearts late after volume unloading by total cavopulmonary connection (TCPC). Methods: Plasma BNP was measured by sandwich immunoassay in 67 patients after a modified Fontan procedure. BNP levels were compared with age and sex-specific normal values, clinical and echocardiographic data, and results of exercise testing. Results: BNP had a wide range of 5-290 pg/ml, but was normal in 81% of patients, and median BNP was only 13 pg/ml. There was no difference between males and females, between patients with left or right ventricular morphology, and no correlation was found between BNP and age, post-operative follow-up period, maximum exercise capability, peak oxygen uptake, or blood oxygen saturation. New York Heart Association class I patients had lower BNP than class II patients (p = 0.04). Plasma BNP concentration was positively correlated to the number of specific sequelae (r = 0.59, p b 0.001), and to severity of atrioventricular regurgitation (r = 0.38, p = 0.002). 5/13 patients with elevated BNP died during follow-up. Conclusion: BNP plasma concentration was normal in the majority of patients up to 15 years after TCPC. Elevated and increasing BNP levels were associated with increased morbidity and late mortality.

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Section: Resultsmentioning

confidence: 99%

“…Therefore, one possible explanation for the surprisingly low BNP levels is the reduced ventricular preload in patients with Fontan circulation together with a limited preload reserve [15,16].…”

Section: Resultsmentioning

confidence: 99%

B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

Koch

Zink

Singer

et al. 2008

European J of Heart Fail

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“…As a consequence, Fontan patients often have suboptimal hemodynamic conditions compared with normal biventricular subjects, such as higher venous pressure and lower CO (58,59). More importantly, the single-ventricle defect significantly impairs the regulatory capacity of the circulatory system, resulting in profound cardiovascular limitations under stress, typically during exercise (27,62,76).…”

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confidence: 99%

Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study

Liang

Senzaki

Kurishima

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study. Am J Physiol Heart Circ Physiol 307: H1056 -H1072, 2014. First published July 25, 2014 doi:10.1152/ajpheart.00245.2014The physiological limitations of the Fontan circulation have been extensively addressed in the literature. Many studies emphasized the importance of pulmonary vascular resistance in determining cardiac output (CO) but gave little attention to other cardiovascular properties that may play considerable roles as well. The present study was aimed to systemically investigate the effects of various cardiovascular properties on clinically relevant hemodynamic variables (e.g., CO and central venous pressure). To this aim, a computational modeling method was employed. The constructed models provided a useful tool for quantifying the hemodynamic effects of any cardiovascular property of interest by varying the corresponding model parameters in model-based simulations. Herein, the Fontan circulation was studied compared with a normal biventricular circulation so as to highlight the unique characteristics of the Fontan circulation. Based on a series of numerical experiments, it was found that 1) pulmonary vascular resistance, ventricular diastolic function, and systemic vascular compliance play a major role, while heart rate, ventricular contractility, and systemic vascular resistance play a secondary role in the regulation of CO in the Fontan circulation; 2) CO is nonlinearly related to any single cardiovascular property, with their relationship being simultaneously influenced by other cardiovascular properties; and 3) the stability of central venous pressure is significantly reduced in the Fontan circulation. The findings suggest that the hemodynamic performance of the Fontan circulation is codetermined by various cardiovascular properties and hence a full understanding of patientspecific cardiovascular conditions is necessary to optimize the treatment of Fontan patients.

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“…A study by Szabo et al (40) reported increased E a and decreased E es as well using pressure-volume analysis conducted on measurements made in a dog SV model. In addition to experimental studies, theoretical models have also predicted similar changes in E a , E es , and cardiac reserve in a Fontan circulation (14,22,28).Most of the studies thus far on the Fontan circulation can be broadly categorized into two types: 1) those that study the Fontan circulation as a whole using in vivo animal and human studies (35,36,40); and 2) those that study the fluid mechanics of the surgically created TCPC in isolation from the SV circulation (27,41,42). There have not been many studies that have connected the two, i.e., those that relate the hemodynamics of the TCPC to upstream hemodynamics and cardiac function.…”

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confidence: 99%

“…Most of the studies thus far on the Fontan circulation can be broadly categorized into two types: 1) those that study the Fontan circulation as a whole using in vivo animal and human studies (35,36,40); and 2) those that study the fluid mechanics of the surgically created TCPC in isolation from the SV circulation (27,41,42). There have not been many studies that have connected the two, i.e., those that relate the hemodynamics of the TCPC to upstream hemodynamics and cardiac function.…”

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confidence: 99%

The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise

Sundareswaran¹,

Pekkan²,

Dasi³

et al. 2008

American Journal of Physiology-Heart and Circulatory Physiology

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140

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AP. The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise. Am J Physiol Heart Circ Physiol 295: H2427-H2435, 2008. First published October 17, 2008 doi:10.1152/ajpheart.00628.2008Little is known about the impact of the total cavopulmonary connection (TCPC) on resting and exercise hemodynamics in a single ventricle (SV) circulation. The aim of this study was to elucidate this mechanism using a lumped parameter model of the SV circulation. Pulmonary vascular resistance (1.96 Ϯ 0.80 WU) and systemic vascular resistances (18.4 Ϯ 7.2 WU) were obtained from catheterization data on 40 patients with a TCPC. TCPC resistances (0.39 Ϯ 0.26 WU) were established using computational fluid dynamic simulations conducted on anatomically accurate three-dimensional models reconstructed from MRI (n ϭ 16). These parameters were used in a lumped parameter model of the SV circulation to investigate the impact of TCPC resistance on SV hemodynamics under resting and exercise conditions. A biventricular model was used for comparison. For a biventricular circulation, the cardiac output (CO) dependence on TCPC resistance was negligible (sensitivity ϭ Ϫ0.064 l ⅐ min Ϫ1 ⅐ WU Ϫ1 ) but not for the SV circulation (sensitivity ϭ Ϫ0.88 l ⅐ min Ϫ1 ⅐ WU Ϫ1 ). The capacity to increase CO with heart rate was also severely reduced for the SV. At a simulated heart rate of 150 beats/min, the SV patient with the highest resistance (1.08 WU) had a significantly lower increase in CO (20.5%) compared with the SV patient with the lowest resistance (50%) and normal circulation (119%). This was due to the increased afterload (ϩ35%) and decreased preload (Ϫ12%) associated with the SV circulation. In conclusion, TCPC resistance has a significant impact on resting hemodynamics and the exercise capacity of patients with a SV physiology. mathematical modeling; cardiac function; congenital heart defects; magnetic resonance imaging THE FONTAN PROCEDURE, composing of connecting the systemic and pulmonary circulation in series via the total cavopulmonary connection (TCPC), is the primary palliative option for physiological correction of single ventricle (SV) congenital heart diseases (2, 3). Although postoperative survival is excellent, with some centers having a mortality of Ͻ1%, studies have repeatedly demonstrated poor functional outcome in survivors (15-18), including significantly reduced exercise capacity, diminished cardiac output (CO), and risks of heart failure (5, 10 -12, 16, 32, 35, 36, 40). Among all the parameters that come into play, decreased cardiac function in these patients seems to be one of the key players responsible for the poor functional outcome (26, 35). However, the impact of the surgically altered TCPC on cardiac function or functional outcome has not been well understood.Poor cardiac function in SV patients can be associated with many factors. For example, Fogel et al. (8) demonstrated that the presence of the lateral tunnel baffle restricted the motion of the atrioventric...

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Cardiac Rest and Reserve Function in Patients With Fontan Circulation

Cited by 152 publications

References 40 publications

B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study

The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise

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