Ventricular energetics in Fontan circulation: Evaluation with a theoretical model

Nogaki, Mio; Senzaki, Hideaki; Masutani, Satoshi; Kobayashi, Jun; Kobayashi, Toshiki; Sasaki, Nozomu; Asano, Haruhiko; Kyo, Shunei; Yokote, Yuji

doi:10.1046/j.1442-200x.2000.01316.x

Cited by 37 publications

(22 citation statements)

References 32 publications

(43 reference statements)

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“…The sensitivity of CVP to increase in RTCPC was 0.64, implying that a 10% increase in resistance results in a 6.4% increase in CVP. The increase in CVP in the SV has been previously shown using acute in vivo animal experiments (40), human experiments (35), and theoretical experiments (14,22). However, the impact of the TCPC procedure on CVP was shown for the first time in this study.…”

Section: Lumped Parameter Model Validationsupporting

confidence: 42%

“…Pressure-volume loops were used to evaluate the slope of the end-systolic volume elastance, or E es, and the vascular Ea property. These parameters were evaluated based on the methodology outlined by Nogaki et al (22). All authors had full access to the data and take responsibility for its integrity.…”

Section: Modeling Rest/exercise Conditions and Data Analysismentioning

confidence: 99%

mentioning

confidence: 92%

“…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: 95%

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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

110

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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Section: Lumped Parameter Model Validationsupporting

confidence: 42%

Section: Modeling Rest/exercise Conditions and Data Analysismentioning

confidence: 99%

mentioning

confidence: 92%

mentioning

confidence: 95%

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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

110

140

View full text Add to dashboard Cite

show abstract

“…The other coupling studies in Fontan patients used similar methods as ours or even much simplified, less‐rigorous methods, but did not include similarly studied non‐Fontan patients to determine whether VA parameters were abnormal relative to persons without Fontan circulation 30, 31. A mathematical simulation study and an animal study of acute Fontan physiology indicated that immediately after creation of a Fontan circulation, Ees is mildly reduced whereas Ea is increased 24, 32. In contrast, chronically, in adult Fontan patients, we found that contractility was significantly decreased as assessed by multiple load‐insensitive measures of ventricular contractility (Ees, PRSW, and PPI) whereas Ea was similar to age, sex, and body size matched controls without CHD.…”

Section: Discussionmentioning

confidence: 99%

Ventricular‐Arterial Function and Coupling in the Adult Fontan Circulation

Saiki

Eidem

Ohtani

et al. 2016

JAHA

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BackgroundIn adult Fontan patients, ventricular or arterial dysfunction may impact homeostasis of the Fontan circulation and predispose to heart failure. We sought to characterize ventricular‐arterial (VA) properties in adult Fontan patients.Methods and ResultsAdult Fontan patients (n=170), including those with right (SRV, n=57) and left (SLV, n=113) dominant ventricular morphology, were compared to age, sex, and body size matched controls (n=170). Arterial function, load‐insensitive measures of contractility, VA coupling, diastolic function, and ventricular efficiency were assessed. Compared to controls, Fontan patients had similar arterial (Ea), but lower end‐systolic ventricular (Ees), elastance, preload recruitable stroke work and peak power index, impaired VA coupling, eccentric remodeling, reduced ventricular efficiency and increased diastolic stiffness (P<0.05 for all). Ventricular efficiency declined steeply with higher heart rate in Fontan, but not control, patients. Among Fontan patients (n=123) and controls (n=162) with preserved cardiac index (CI; ≥2.5 L/min per m2), Fontan patients had worse contractility than controls, but CI was preserved owing to relative tachycardia, lower afterload, and eccentric remodeling. However, 25% of Fontan patients had reduced CI and were distinguished from those with preserved CI by less‐eccentric remodeling and worse diastolic function, rather than more‐impaired contractility.ConclusionsAdult Fontan patients have contractile and diastolic dysfunction with normal afterload, impaired VA coupling, and reduced ventricular efficiency with heightened sensitivity to heart rate. Maintenance of CI is dependent on lower afterload, eccentric remodeling, and relative preservation of diastolic function. These data contribute to our understanding of circulatory physiology in adult Fontan patients.

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Haemodynamic profiles in adult Fontan patients: associated haemodynamics and prognosis

Miranda

Borlaug

Hagler

et al. 2019

European J of Heart Fail

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Aims The Fontan operation is associated with significant long‐term morbidity and mortality, posing challenges in management. No haemodynamic classification has been established to aid management and prognostication of patients with Fontan palliation. Our aim was to assess haemodynamic profiles for Fontan patients and evaluate their relationships to prognosis. Methods and results Eighty‐four adult Fontan patients without obstruction or significant valve disease undergoing cardiac catheterization for Fontan‐related co‐morbidities were divided into four different haemodynamic profiles based on normal/high Fontan pressures (FP) (< 15 or ≥ 15 mmHg) and low/normal cardiac index (CI) (< 2.5 or ≥ 2.5 L/min/m2). Fourteen patients had low CI/high FP (17%), 24 low CI/normal FP (29%), 20 normal CI/high FP (24%), and 26 normal CI/normal FP (31%). Demographic and clinical data were similar among groups except for a trend towards a higher prevalence of cirrhosis in the normal CI/high FP (50%) group. Systemic vascular afterload, assessed by systemic vascular resistance and effective arterial elastance, was higher in patients with low CI/high FP and low CI/normal FP as compared to normal CI profiles. Pulmonary vascular resistance indices were higher in patients with low CI/high FP than all other profiles. The normal CI/high FP haemodynamic profile was an independent predictor of mortality (hazard ratio 4.1, 95% confidence interval 1.2–11.5). Heterotaxy and protein‐losing enteropathy were also predictors of mortality on the multivariate model. Conclusion The proposed haemodynamic classification provides prognostic information in adults post‐Fontan with patients in the normal CI/high FP profile having worse survival. Whether this classification can guide management in these patients deserves further investigation.

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Ventricular energetics in Fontan circulation: Evaluation with a theoretical model

Abstract: Thus, it was inferred that Fontan circulation had intrinsic disadvantages and this may explain, in part, abnormal functional status and decline in survival following this procedure.

Cited by 37 publications

References 32 publications

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

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

Ventricular‐Arterial Function and Coupling in the Adult Fontan Circulation

Haemodynamic profiles in adult Fontan patients: associated haemodynamics and prognosis

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