The Fontan operation

Hsu, Daphne T.

doi:10.1097/mop.0000000000000271

Cited by 27 publications

(3 citation statements)

References 45 publications

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“…The factors affecting systemic venous flow return are heartbeat, respiration, skeletal-muscle pumping function, and patient posture 3,4 . In patients with Fontan circulation, the need for passive pulmonary perfusion leads to an altered systemic venous flow pattern that contributes to an increase in hepatic afterload and splanchnic venous hypertension, which may finally lead to long-term complications, such as failure of Fontan circulation and eventually death 5–10 . Experimental placement of a unidirectional valve within the IVC has been explored to prevent retrograde flow and lower hepatic venous pressure 11 .…”

Section: Introductionmentioning

confidence: 99%

Heart beat but not respiration is the main driving force of the systemic venous return in the Fontan circulation

Gabbert

Hart

Jerosch‐Herold

et al. 2019

Sci Rep

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The Fontan procedure provides relief from cyanosis in patients with univentricular hearts. A major clinical unmet need is to understand whether the venous flow patterns of the Fontan circulation lead to the development of congestive hepatopathy and other life-threatening complications. Currently, there is no consensus on whether heart beat or respiration is the main driving force of venous return and which one affects the periodic flow changes for the most (i. e., pulsatility). The present study, for the first time, quantified respiratory and cardiac components of the venous flow in the inferior vena cava (IVC) of 14 Fontan patients and 11 normal controls using a novel approach (“physio-matrix”). We found that in contrast to the normal controls, respiration in Fontan patients had a significant effect on venous flow pulsatility, and the ratio of respiration-dependent to the cardiac-dependent pulsatility was positively associated with the retrograde flow. Nevertheless, the main driving force of net IVC flow was the heart beat and not respiration. The separate analysis of the effects of respiration and heart beat provides new insights into the abnormal venous return patterns that may be responsible for adverse effects on liver and bowel of the patients with Fontan circulation.

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Section: Introductionmentioning

confidence: 99%

Heart beat but not respiration is the main driving force of the systemic venous return in the Fontan circulation

Gabbert

Hart

Jerosch‐Herold

et al. 2019

Sci Rep

View full text Add to dashboard Cite

show abstract

“…One -third of deaths occur suddenly, whereas the majority of patients die after progressive health deterioration over a few months, mainly of chronic HF. 80 Such patients could benefit from incorporating PC into cardiac care. [83][84][85][86] The models of PC provision in this population still need to be established, respecting local traditions and international experiences.…”

Section: Setting Up Communicationmentioning

confidence: 99%

“…Successful surgical and percutaneous interventions at young age resulted in a growing population of young adults who require lifelong both cardiac and noncardiac care, 76,77 including PC in more complex situations. [78][79][80] The access to optimal, comprehensive care for people living with grown -up congenital heart disease (GUCH) should be regarded as a standard element of medical care and social responsibility.…”

Section: Setting Up Communicationmentioning

confidence: 99%