Subdiaphragmatic venous hemodynamics in patients with biventricular and Fontan circulation after diaphragm plication

Hsia, Tain‐Yen; Khambadkone, Sachin; Bradley, Scott M.; Leval, Marc R. de

doi:10.1016/j.jtcvs.2007.07.044

Cited by 34 publications

(32 citation statements)

References 26 publications

(63 reference statements)

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“…Lacking the ventricular power source, the systemic venous pressure and the respiratory mechanics become the dominant forces for moving pulmonary blood flow. Respiration-gated magnetic resonance (MR) imaging 1–3,5–7 has revealed significant differences to the ECG-triggered acquisitions often applied in modeling studies. 5 Venous and pulmonary arterial flows increase during inspiration and decrease in expiration.…”

Section: Introductionmentioning

confidence: 99%

“…5 Venous and pulmonary arterial flows increase during inspiration and decrease in expiration. 1–3 This pattern is particularly accentuated in the inferior venous return 1–7 due to the recoil of the thoracic cage during expiration and the absence of a venous valve. 2 For many patients, as inspiration wanes, both the inferior vena cava (IVC) and hepatic vein (HV) flows can experience a period of retrograde motion away from the heart.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 The idea of implanting a valve in the IVC originated with Fontan and Baudet. 8 Hsia et al 2 suggested a valve to reduce hepatic congestion.…”

Section: Introductionmentioning

confidence: 99%

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Control of Respiration-Driven Retrograde Flow in the Subdiaphragmatic Venous Return of the Fontan Circulation

Vukicevic¹,

Conover²,

Jaeggli³

et al. 2014

ASAIO Journal

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Respiration influences the subdiaphragmatic venous return in the total cavopulmonary connection (TCPC) of the Fontan circulation whereby both the inferior vena cava (IVC) and hepatic vein flows can experience retrograde motion. Controlling retrograde flows could improve patient outcomes. Using a patient-specific model within a Fontan mock circulatory system with respiration, we inserted a valve into the IVC to examine its effects on local hemodynamics while varying retrograde volumes by changing vascular impedances. A bovine valved conduit reduced IVC retrograde flow to within 3% of antegrade flow in all cases. The valve closed only under conditions supporting retrograde flow and its effects on local hemodynamics increased with larger retrograde volume. Liver and TCPC pressures improved only while the valve leaflets were closed while cycle-averaged pressures improved only slightly (italic>1 mm Hg). Increased pulmonary vascular resistance raised mean circulation pressures but the valve functioned and cardiac output improved and stabilized. Power loss across the TCPC improved by 12–15% (pbold>0.05) with a valve. The effectiveness of valve therapy is dependent on patient vascular impedance.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Control of Respiration-Driven Retrograde Flow in the Subdiaphragmatic Venous Return of the Fontan Circulation

Vukicevic¹,

Conover²,

Jaeggli³

et al. 2014

ASAIO Journal

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“…Hsia et al (10) present data on subdiaphragmatic venous flow dynamics in patients with Fontan circulation after diaphragm plication. Patients with biventricular circulation were compared with Fontan patients with normal diaphragms and Fontan patients who had required plication of the diaphragm after phrenic nerve damage.…”

Section: Fontan Surgerymentioning

confidence: 99%

The Year in Congenital Heart Disease

Graham

2008

Journal of the American College of Cardiology

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Long-Term Management of Tetralogy of Fallot (TF)Articles related to long-term management of the status of older children and young adults after repair of TF include issues related to assessment of pulmonary regurgitation and timing pulmonary valve replacement as well as indications for and results of implantation of defibrillators.Gengsakul et al.(1) report a matched cohort study of 82 patients with pulmonary valve replacement (PVR) after TF repair without a history of ventricular arrhythmia who were compared with non-PVR control subjects. Oxygen consumption at peak exercise did not change in either group. For PVR subjects, there was a significant reduction in pulmonary valve regurgitation (PR), tricuspid valve regurgitation (TR), and right ventricular (RV) size and dysfunction on echocardiography. Symptoms and functional class improved after PVR, but a change in arrhythmia was not detected. There were no sudden deaths in the PVR subjects, whereas 4 patients died suddenly in the non-PVR group.Meijboom et al.(2) report on 67 patients who were followed from 15 Ϯ 3 years until 27 Ϯ 3 years after TF surgery. Twenty-two patients had mild-to-moderate PR, and no significant changes occurred during follow-up. Of 45 patients with severe PR and severe RV dilation, 28 (62%) remained free of symptoms and did not undergo PVR. No additional changes in RV size or exercise capacity were found. Seventeen patients had symptoms and underwent PVR; 9 of 17 improved clinically and echocardiographically, and QRS duration shortened. Refraining from PVR in asymptomatic patients led to no measurable deterioration in 25 of 28 patients. Referring symptomatic patients for PVR led to improvement in 9 of 17 patients. This article highlights the dilemma in following asymptomatic patients with significant PR. Although most showed no measurable deterioration, in 24% there were questionable or unsatisfactory results for this type of management.Henkens et al.(3) analyzed the influence of pre-operative PR severity and RV size and function on outcome in 27 adults who had cardiac magnetic resonance imaging (MRI) before and after PVR. PR was not related to RV dimensions or function before PVR, and severity of PR did not influence changes in RV dimensions after PVR. These data suggest that the timing of PVR should be based on indexed RV end-systolic volume and corrected RV ejection fraction (EF) rather than severity of PR. It is unclear how PR cannot be related to RV dimensions in this article. Nevertheless, the preceding 3 reports emphasize that diligence is needed in follow-up of these patients and MRI, plus exercise studies can help in providing optimal timing for PVR before deterioration of RV function occurs. This can be a difficult enterprise despite all of our efforts. If we had a perfect valve it would be much easier, but such is not the case.Khairy et al. (4) report on implantable cardioverterdefibrillators (ICDs) in TF patients. A total of 121 patients were enrolled and followed for a median of 3.7 years. The ICDs were implanted for primary pr...

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“…Previous studies focusing on functionally healthy patients after total caval pulmonary connection suggested the venae cavae flows and pressures to be biphasic complex waveforms (6)(7)(8)(9). Recent attempts to quantify the pulsatility in Fontan patients revealed significant differences among different patient cohorts and suggested pulsatility as a promising parameter to predict late Fontan failure (10).…”

Section: Introductionmentioning

confidence: 99%

Pulsatile venous waveform quality in Fontan circulation-clinical implications, venous assists options and the future

Koçyıldırım

Dur²,

Soran³

et al. 2012

Anadolu Kardiyol Derg

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Objective: Functionally univentricular heart (FUH) anomalies are the leading cause of death from all structural birth defects. Total cavopulmonary connection (TCPC) is the last stage of the palliative surgical reconstruction with significant late hemodynamic complications requiring high-risk heart transplantation. Alternative therapeutic options for these critically ill patients are crucial. In Phase I, we investigated the effect of pulsatility of venous flow (VF) waveform on the performance of functional and "failing" Fontan (FF) patients based on conduit power loss. In phase 2, the effect of enhanced external counter pulsation on Fontan circulation flow rates is monitored. Methods: In phase 1, Doppler VFs were acquired from FF patients with ventricle dysfunction. Using computational fluid dynamics (CFD), hemodynamic efficiencies of the FF, functional and in-vitro generated mechanically assisted VF waveforms were evaluated. In phase 2, Fontan circulation on sheep model was created and enhanced external counter pulsation (EECP) applied. Results: Variations in the pulsatile content of the VF waveforms altered conduit efficiency notably. High frequency and low amplitude oscillations lowered the pulsatile component of power losses in FF VF waveforms. The systemic venous flow, pulmonary artery and aorta flows increased by utilizing EECP. Conclusion: Our data highlighted the significance of VF pulsatility on energy efficiency inside SV circulation and the feasibility of VF waveform optimization. EECP assist in Fontan circulation can result in venous flow augmentation. (Anadolu Kardiyol Derg 2012; 12: 420-6) Key words: Fontan, Fontan circulation, failing Fontan circulation, enhanced external counterpulsation, animal experiment, content of the VF waveforms ÖZET Amaç: Fonksiyonel tek ventrikül anomalileri tüm yapısal konjenital kalp anomalileri arasında beşinci en sık defekt olup, önde gelen bir ölüm sebebidir. Total kavopulmoner konneksiyon ameliyatı palyatif cerrahi rekonstrüksiyon ameliyatlarının en son basamağı olup, çoğunlukla kalp transplantasyonu gerektiren hemodinamik komplikasyonları mevcuttur. İleri derecedeki hasta bu kişilerde alternatif tedavi seçenekleri gereklidir. Çalışmamızın faz I evresinde, fonsiyonel ve bozulmuş Fontan dolaşımı olan hastalardaki kondüit enerji kaybı baz alınarak pulsatil venöz dalga niteliğini çalıştık. İkinci fazda ise, güçlendirilmiş eksternal kontrpulsasyonun Fontan dolaşımı akımları üzerindeki etkisini araştırdık. Yöntemler: Faz I'de, ventriküler fonksiyon bozukluğu olan bozulmuş Fontan dolaşımı olan hastalarda Doppler venöz akımları analiz edildi. Bilgisayarlı akışkan dinamikleri yöntemiyle bozulmuş Fontan dolaşımının hemodinamik özellikleri ve venöz dalga niteliği değerlendirildi. Faz II' de Fontan dolaşımı gerçekleştirilen koyun modelinde güçlendirilmiş eksternal kontrpulsasyon uygulandı. Bulgular: Venöz akım dalga niteliği pulsatilite ilişkisi tespit edildi. Bozulmuş Fontan dolaşımı olan hastalardaki yüksek frekans ve düşük amplitüdlü osilasyonların, venöz dalga nitel...

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Subdiaphragmatic venous hemodynamics in patients with biventricular and Fontan circulation after diaphragm plication

Cited by 34 publications

References 26 publications

Control of Respiration-Driven Retrograde Flow in the Subdiaphragmatic Venous Return of the Fontan Circulation

Control of Respiration-Driven Retrograde Flow in the Subdiaphragmatic Venous Return of the Fontan Circulation

The Year in Congenital Heart Disease

Pulsatile venous waveform quality in Fontan circulation-clinical implications, venous assists options and the future

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