Early and late arrhythmias after the Fontan operation: predisposing factors and clinical consequences.

Gewillig, Marc; Wyse, Richard K.H.; Leval, Marc R. de; Deanfield, JE

doi:10.1136/hrt.67.1.72

Cited by 151 publications

(70 citation statements)

References 17 publications

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“…Because of the heterogeneity of cardiac anatomy, we used a qualitative, subjective assessment of systemic ventricular function from multiview 2-dimensional echocardiography, grading it as normal or mildly, moderately, or severely impaired, 20 while accounting for significant AV valve regurgitation by similarly grading the systemic ventricular end-systolic diameter. Right atrial (RA) and LA length and width were measured from an apical 4-chamber view, as previously described, 21 and atrial volumes were quantified by tracing the atrial endocardial border at endsystole and applying the biplane area-length method. 22 Cardiopulmonary exercise testing was performed in a subgroup of 28 patients according to the modified Bruce protocol.…”

Section: Clinical Investigation Protocolsmentioning

confidence: 99%

Neurohormonal Activation and the Chronic Heart Failure Syndrome in Adults With Congenital Heart Disease

et al. 2002

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Background — Neurohormonal activation characterizes chronic heart failure, relates to outcome, and is a therapeutic target. It is not known whether a similar pattern of neurohormonal activation exists in adults with congenital heart disease and, if so, whether it relates to common measures of disease severity or whether cardiac anatomy is a better discriminant. Methods and Results — Concentrations of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1), renin, aldosterone, norepinephrine, and epinephrine were determined in 53 adults with congenital heart disease, comprising 4 distinct anatomic subgroups (29 female; 33.5±1.5 years of age; New York Heart Association class 2.0±0.1, mean±SEM) and 15 healthy control subjects (8 female; 32.3±1.3 years of age). Systemic ventricular function was graded by a blinded echocardiographer as normal or mildly, moderately, or severely impaired. Adults with congenital heart disease had elevated levels of ANP (56.6 versus 3.1 pmol/L), BNP (35.8 versus 5.7 pmol/L), ET-1 (2.5 versus 0.7 pmol/L, all P <0.0001), renin (147 versus 16.3 pmol/L), norepinephrine (2.2 versus 1.6 pmol/L, both P <0.01) and aldosterone (546 versus 337 pmol/L, P <0.05). There was a highly significant stepwise increase in ANP, BNP, ET-1, and norepinephrine according to New York Heart Association class and systemic ventricular function, with even asymptomatic patients having evidence of significant neurohormonal activation. In contrast, there was no direct relationship between the 4 anatomic subgroups and any of the neurohormones studied. Conclusions — Neurohormonal activation in adult congenital heart disease bears the hallmarks of chronic heart failure, relating to symptom severity and ventricular dysfunction and not necessarily to anatomic substrate. Neurohormonal antagonism across this large and anatomically diverse population should be considered.

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Section: Clinical Investigation Protocolsmentioning

confidence: 99%

Neurohormonal Activation and the Chronic Heart Failure Syndrome in Adults With Congenital Heart Disease

et al. 2002

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“…In that particular study, they also reported that the preoperative oxygen saturation was not a risk factor for postoperative arrhythmia (3). Different from the study by Gewillig et al (3), we investigated the preoperative right atrial pressure rather than the preoperative right atrial size.…”

Section: Discussionmentioning

confidence: 72%

“…While the extracardiac conduit procedure was determined to be a risk factor in the early postoperative period in the study by Kumar et al (1), Chowdhury et al (2) determined bilateral superior vena cava (SVC) and systemic ventricular dysfunction to be risk factors for supraventricular arrhythmia following the extracardiac conduit Fontan operation. In the studies by Gewillig et al (3) and Peters et al (4), advanced age, dilated right atrium, increased preoperative pulmonary artery pressure, increased right atrial pressure, and poor ventricular function were reported to be risk factors.…”

Section: Introductionmentioning

confidence: 99%

“…Development of postoperative arrhythmias in patients undergoing the Fontan operation carries a significant morbidity. For this purpose, the risk factors with respect to postoperative arrhythmia following the Fontan operation have been evaluated in previous studies (1)(2)(3)(4). While the extracardiac conduit procedure was determined to be a risk factor in the early postoperative period in the study by Kumar et al (1), Chowdhury et al (2) determined bilateral superior vena cava (SVC) and systemic ventricular dysfunction to be risk factors for supraventricular arrhythmia following the extracardiac conduit Fontan operation.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for postoperative arrhythmia in patients with physiologic univentricular hearts undergoing Fontan procedure

Çeli̇k¹,

Sarıtaş²,

Tatar³

et al. 2012

Anadolu Kardiyol Derg

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Objective: Advanced age, dilated right atrium, increased preoperative pulmonary artery pressure, increased right atrial pressure, technique of operation, and poor ventricular function were reported to be risk factors for postoperative arrhythmia. Aim of this study is to determine the risk factor for postoperative arrhythmia after Fontan operation with regard to ventricle dominancy and hemodynamic parameters. Methods: In this retrospective study, the data of the patients including age, weight, dominant ventricle, type of cardiac anomaly, previous operations, duration of cardiopulmonary bypass (CPB), duration of aortic clamping, cardiac rhythm, pulmonary artery pressure, the Nakata Index, systemic atrioventricular (AV) valve insufficiency were obtained from the hospital records, the echocardiographic files, and cardiac catheterization records. Patients were assigned to dominant left ventricle or dominant right ventricle groups. Statistical analysis was performed using the Mann-Whitney U test. Results: Arrhythmia was observed in 21 (52.5%) patients in the postoperative period. No postoperative arrhythmia was observed in patients with a right atrial pressure of <5 mmHg, whereas postoperative arrhythmias were observed in patients with a right atrial pressure of ≥5 mmHg (p<0.05). When the effects of preoperative and postoperative pulmonary artery pressures on postoperative arrhythmia were evaluated, postoperative arrhythmia was determined in only 2 (12.5%) of 8 patients with a preoperative mean pulmonary artery pressure of ≤9 mmHg, whereas postoperative arrhythmia was observed in 19 (59.3%) of 32 patients with a preoperative pulmonary artery pressure of ≥10 mmHg. A preoperative mean pulmonary artery pressure of >10 mmHg increased the risk of postoperative arrhythmia (p<0.02). Postoperative arrhythmia was determined in 8 (53%) of 15 patients with a dominant right ventricle, and in 13 (52%) of 25 patients with a dominant left ventricle (p>0.05). Conclusion: While a preoperative mean pulmonary artery pressure of >10 mmHg and a preoperative right atrial pressure of >5 mmHg were the risk factors for postoperative arrhythmia in patients undergoing Fontan procedure, the right or left ventricular dominance was not a risk factor. (Anadolu Kardiyol Derg 2012; 12: 347-51) Key words: Univentricular heart, Fontan operation, arrhythmia, risk factors Original Investigation Özgün Araşt›rma 347ÖZET Amaç: Literatürde yapılan çalışmalarda ileri yaş, sağ atriyum boyutunun büyüklüğü, ortalama pulmoner arter basıncı, sağ atriyum basıncı, sistemik ventrikülün düşük ejeksiyon fraksiyonu, ameliyat tekniği postoperatif aritmi için risk faktörü olarak saptanmıştır. Bu çalışmada sistemik dolaşımı sağlayan 'dominant ventrikül' ün sağ ventrikül ya da sol ventrikül olmasının ve hemodinamik parametrelerin postoperatif aritmi açısından risk faktörü olup olmadığı araştırılmıştır.Yöntemler: Fontan ameliyatı yapılmış 1997 ve 2008 yılları arasındaki 40 hastanın verileri retrospektif olarak değerlendirildi. Hastaların ekokardiyografi notları, kard...

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“…These may lead to severe hypotension by causing an increase in pulmonary venous atrial pressure in a circulation which lacks a right-sided ventricle. The consequence of these arrhythmias and their predisposing factors have been analysed retrospectively by Gewillig et al 8 Eleven patients (10.6%) developed peri- Usually upright including V I *Range in beats 9 rain -1. tRange (mean). ~PR interval varies with heart operative tachycardias which, despite intensive medical treatment, were fatal in ten.…”

Section: Electrocardiogrammentioning

confidence: 99%

Monitoring during paediatric cardiac anaesthesia

Purday

1994

Can J Anaesth

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Monitoring of paediatric anaesthesia has become increasingly more complex in recent years (precordial, oesophageal or paratracheal). Specialized monitoring includes the monitoring of mixed venous oxygenation saturation (S~O2) which is being increasingly used within the critical care area. Transoesophageal echocardiography (TOE) has become accepted in adult cardiac surgery particularly in the fields of mitral valve repair and aortic root surgery, where it allows immediate assessment of the adequacy of repair. The place of TOE in congenital heart disease is now becoming more clearly defined. Cerebral function monitoring is an area of a great deal of research and several new monitoring methods are under review. The use of the thromboelastogram in monitoring coagulation has been found to decrease blood and fluid replacement during liver transplantation and its use during cardiac surgery is increasing. Other end organs that are affected by cardiopulmonary bypass (CPB) include the gut; liver and immune system, possibly leading to multi-organ failure in some cases, and interest is being shown in their monitoring.The purpose of this review is to present the recent publications relating to specific areas of both standard and specialized monitoring and indicate areas where these monitors may prove particularly useful to the practitioner involved in the care of paediatric cardiac patients. Routine monitoring ElectrocardiogramThe ECG displays the electrical activity of the heart. Abnormalities in the ECG can reflect alterations in rate or rhythm and changes in the ST segment may incidate underlying ischaemia. The normal ECG in childhood changes with age and shows several differences from the adult, particularly in the first few years of life where the right ventrical mass is dominant. There are several general changes that occur with increasing age (Table I). Heart rate (HR), frontal plane QRS vector (axis), PR interval, R wave heights and T waves are some of the factors that alter with age (Table II) and the reader is referred to a more specialized review for further information. 1,2 In adult cardiac surgery there has been investigation of perioperative myocardial ischaemia, its prognosis, and the best way of detecting it. 3,4 In children, however, there has been little work looking at the ST segment. Bell et al. ~ reported three cases of ST changes in neonates consistent with myocardial ischaemia. The first case involved a child of 26 wk who developed ST changes during awake laryngoscopy and lung retraction that were presumed to be related to myocardial hypoxia, although pulse oximetry readings were not mentioned. In the second case, ST changes improved on starting trinitroglycerine, isoproterenol and dopamine and in the third were related to ectiocardiographic changes. Cherian and Rao 6 associate the ST segment with the adequacy of coronary blood flow during the arterial switch operation for transposition. Observing leads I and V 5 for the left coronary and lead II for the right, greater than 1 mm elevation for more tha...

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Early and late arrhythmias after the Fontan operation: predisposing factors and clinical consequences.

Cited by 151 publications

References 17 publications

Neurohormonal Activation and the Chronic Heart Failure Syndrome in Adults With Congenital Heart Disease

Neurohormonal Activation and the Chronic Heart Failure Syndrome in Adults With Congenital Heart Disease

Risk factors for postoperative arrhythmia in patients with physiologic univentricular hearts undergoing Fontan procedure

Monitoring during paediatric cardiac anaesthesia

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