Competitive pulmonary flow in infancy: the effect of respiration

Henneveld, H; Sreeram, Narayanswami; Hitchcock, J. F.

doi:10.1016/s0167-5273(98)00318-0

Cited by 3 publications

(1 citation statement)

References 3 publications

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“…This reduction in cardiac output is exaggerated in the Fontan circuit, also reducing antegrade flow from the SVC into the branch pulmonary arteries. These findings highlight the importance of early extubation and/or minimizing positive pressure post-operatively after Fontan completion (23,58). Jardin et al proposed that in otherwise healthy patients with respiratory distress syndrome, leftward displacement of the interventricular septum limits LV filling and cardiac output (56).…”

Section: Acute Changes In Pulmonary Vascular Resistance and Positive ...mentioning

confidence: 97%

Impairments in Pulmonary Function in Fontan Patients: Their Causes and Consequences

Laohachai

Ayer

2022

Front. Pediatr.

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Patients with a Fontan circulation lack a sub-pulmonary ventricle with pulmonary blood flow passively redirected to the lungs. In the Fontan circulation, ventilation has a significant influence on pulmonary blood flow and cardiac output both at rest and with exercise. Children and adults with a Fontan circulation have abnormalities in lung function. In particular, restrictive ventilatory patterns, as measured by spirometry, and impaired gas transfer, as measured by the diffusing capacity of carbon monoxide, have been frequently observed. These abnormalities in lung function are associated with reduced exercise capacity and quality of life. Moderate to severe impairment in lung volumes is independently associated with reduced survival in adults with congenital heart disease. Skeletal and inspiratory muscle weakness has also been reported in patients with a Fontan circulation, with the prospect of improving respiratory muscle function through exercise training programs. In this review, we will present data on cardiopulmonary interactions in the Fontan circulation, the prevalence and severity of impaired lung function, and respiratory muscle function in this population. We will discuss potential causes for and consequence of respiratory impairments, and their impact on exercise capacity and longer-term Fontan outcome. We aim to shed light on possible strategies to reduce morbidity by improving respiratory function in this growing population of patients.

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Section: Acute Changes In Pulmonary Vascular Resistance and Positive ...mentioning

confidence: 97%

Impairments in Pulmonary Function in Fontan Patients: Their Causes and Consequences

Laohachai

Ayer

2022

Front. Pediatr.

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Mechanical ventilation strategy following Glenn and Fontan surgeries: On going challenge!

Al‐Eyadhy

2009

Journal of the Saudi Heart Association

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The Glenn and Fontan operations put the pulmonary and systemic circulations in series. It has been shown that positive pressure ventilation (PPV) decreases pulmonary blood flow (PBF) and cardiac output (CO), and negative pressure ventilation (NPV) significantly improves PBF and CO. If early extubation is not achievable, the postoperative ventilator management strategy should aim at promoting PBF and CO by lowering pulmonary vascular resistance (PVR) and intrathoracic pressure. Multiple ventilator strategies have been evaluated to optimize this physiology, including high frequency ventilation, hyperventilation post Glenn, hypoventilation post Glenn with buffered pH, and the use of inhaled nitric oxide as an adjunct therapy for mechanical ventilation. In this review, the results of these studies will be reviewed and discussed.

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Augmentation of pulmonary blood flow and cardiac output by non-invasive external ventilation late after Fontan palliation

Charla

Karur

Yamamura

et al. 2020

Heart

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ObjectivesAlthough a life-preserving surgery for children with single ventricle physiology, the Fontan palliation is associated with striking morbidity and mortality with advancing age. Our primary objective was to evaluate the impact of non-invasive, external, thoraco-abdominal ventilation on pulmonary blood flow (PBF) and cardiac output (CO) as measured by cardiovascular magnetic resonance (CMR) imaging in adult Fontan subjects.MethodsAdults with a dominant left ventricle post-Fontan palliation (lateral tunnel or extracardiac connections) and healthy controls matched by sex and age were studied. We evaluated vascular flows using phase-contrast CMR imaging during unassisted breathing, negative pressure ventilation (NPV) and biphasic ventilation (BPV). Measurements were made within target vessels (aorta, pulmonary arteries, vena cavae and Fontan circuit) at baseline and during each ventilation mode.ResultsTen Fontan subjects (50% male, 24.5 years (IQR 20.8–34.0)) and 10 matched controls were studied. Changes in PBF and CO, respectively, were greater following BPV as compared with NPV. In subjects during NPV, PBF increased by 8% (Δ0.20 L/min/m2 (0.10–0.53), p=0.011) while CO did not change significantly (Δ0.17 L/min/m2 (−0.11–0.23), p=0.432); during BPV, PBF increased by 25% (Δ0.61 L/min/m2 (0.20–0.84), p=0.002) and CO increased by 16% (Δ0.47 L/min/m2 (0.21–0.71), p=0.010). Following BPV, change in PBF and CO were both significantly higher in subjects versus controls (0.61 L/min/m2 (0.2–0.84) vs −0.27 L/min/m2 (−0.55–0.13), p=0.001; and 0.47 L/min/m2 (0.21–0.71) vs 0.07 L/min/m2 (−0.47–0.33), p=0.034, respectively).ConclusionExternal ventilation acutely augments PBF and CO in adult Fontan subjects. Confirmation of these findings in larger populations with longer duration of ventilation and extended follow-up will be required to determine sustainability of haemodynamic effects.

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Competitive pulmonary flow in infancy: the effect of respiration

Cited by 3 publications

References 3 publications

Impairments in Pulmonary Function in Fontan Patients: Their Causes and Consequences

Impairments in Pulmonary Function in Fontan Patients: Their Causes and Consequences

Mechanical ventilation strategy following Glenn and Fontan surgeries: On going challenge!

Augmentation of pulmonary blood flow and cardiac output by non-invasive external ventilation late after Fontan palliation

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