Pulsed Doppler echocardiographic assessment of patterns of venous flow after the modified Fontan operation: potential clinical implications

1998 ◽  
Vol 8 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Renate Kaulitz ◽  
Ingrid Luhmer ◽  
Hans Carlo Kallfelz
Keyword(s):  
Cardiac Catheterization ◽  
Fontan Operation ◽  
Right Atrial ◽  
Venous Blood Flow ◽  
Portal Venous Flow ◽  
Venous Flow ◽  
Cavopulmonary Anastomosis ◽  
Hepatic Venous Flow ◽  
Modified Fontan Operation ◽  
Total Cavopulmonary Anastomosis

AbstractTo assess the effect of a modified Fontan operation on systemic venous blood flow and the hepatic circulation, we compared 11 patients having an atriopulmonary connection and 35 with total cavopulmonary anastomosis. The Doppler echocardiographic study of the caval venous, hepatic venous and portal venous flow was performed so as to calculate the pulsatility ratio and the variation of flow with respiration. All patients had undergone cardiac catheterization. In addition, we included specific laboratory investigations to assess function of various organs.Significantly lower maximum velocities of flow at inspiration (0.31±0.12 rn/sec vs 0.45±0.14 m/sec) and expiration (0.23±0.09 rn/sec vs 0.32±0.11 m/sec), less pulsatility (0.43 vs 0.16) and a lower ratio of systolic to diastolic velocity (1.22 vs 1.85) were found in the patients having a cavopulmonary as compared to an atriopulmonary anastomosis. Peak velocities of hepatic venous flow during inspiration and expiration were significantly lower in those with a cavopulmonary anastornosis (p=O.OOl and p<O.OOl, respectively). In these patients, forward flow was extremely dependent on respiration, with decrease or cessation of antegrade flow during expiration in 22 patients. The velocity of portal venous flow was also significantly lower in these patients, although the pulsatility ratio did not differ significantly between the groups (0.5 ± 0.21 and 0.57 ± 0.23, respectively). The ratio of inspiratory and expiratory velocities showed no significant difference between the groups, nor was there any correlation between the pulsatility ratio of the venous vessels or the ratio of peak flow velocities during expiration and the mean systemic venous/right atrial pressure on postoperative cardiac catheterization. Hypoproteinemia was found in 8 patients after total cavopulmonary anastomosis; 9 of 10 patients with protein C deficiency belonged to this group.The dependence of hepatic venous flow on respiration in the presence of a chronically elevated systemic venous pressure in patients after the total cavopulmonary anastornosis may influence hepatic function in the postoperative period.

The modified Fontan operation in hearts associated with atrioventricular valvar atresia or common atrioventricular valve—neoseptation of the atriums using a right atrial flap

1994 ◽  
Vol 4 (4) ◽  
pp. 353-357 ◽  
Author(s):  
Tayyar Sarioglu ◽  
Tufan Paker ◽  
Halil Türkoglu ◽  
Atif Akçevin ◽  
Ayse Sarioglu ◽  
...  
Keyword(s):  
Left Atrium ◽  
Right Atrium ◽  
Fontan Operation ◽  
Right Atrial ◽  
Moderate Hypothermia ◽  
Atrioventricular Valve ◽  
Venous Flow ◽  
The Right ◽  
Modified Fontan Operation ◽  
Common Atrioventricular Valve

SummarySummary Between June 1988 and December 1992, six patients with dominant left and rudimentary right ventricles underwent orthoterminal correction with a modified Fontan operation in which the atriums were neoseptated using a flap constructed from the right atrial wali. Four patients had anomalous systemic venous connections. The operations were performed under direct caval cannulation, standard cardiopulmonary bypass, moderate hypothermia and cardioplegic arrest. After opening the right atrium with a longitudinal incision, the atrial septum was completely resected and the coronary sinus was cut back. The upper wall of the right atrial incision was brought down in such a way that the pulmonary venous atrium was drained into the dominant ventricle via the right-sided or common atrioventricular valve. This was followed by direct connection of the right atrium with its anterior wall reconstructed with pericardium to the pulmonary arteries. In one patient, a left superior caval vein draining to the left atrium was divided and anastomosed to left pulmonary artery. One patient died on the 12th postoperative day with pulmonary infection and sepsis, though he had no hemodynamic problem, and another died on the sixth day due to high pulmonary vascular resistance. The remaining four patients are progressing well at a mean of 23.4 months postoperatively with functional capacity of NYHA I-IT and sinus rhythm. Echocardiographic and angiocardiographic examinations during follow-up showed unobstructed pulmonary and systemic venous pathways in all. This modification of the Fontan operation seems a good alternative technique which creates a contractile left atrium with large enough dimensions and an unobstructed pathway for pulmonary venous flow.

scholarly journals Pulsed Doppler echocardiographic assessment of portal venous flow patterns in patients after the Fontan operation.

Heart ◽  
1993 ◽  
Vol 69 (1) ◽  
pp. 41-46 ◽  
Author(s):  
J Arisawa ◽  
S Morimoto ◽  
J Ikezoe ◽  
H Naitoh ◽  
H Yamagami ◽  
...  
Keyword(s):  
Fontan Operation ◽  
Flow Patterns ◽  
Pulsed Doppler ◽  
Portal Venous Flow ◽  
Venous Flow ◽  
Echocardiographic Assessment

scholarly journals Prophylaxis of thromboembolic complications after the Fontan operation (total cavopulmonary anastomosis)

2005 ◽  
Vol 129 (3) ◽  
pp. 569-575 ◽  
Author(s):  
Renate Kaulitz ◽  
Gerhard Ziemer ◽  
Ralf Rauch ◽  
Monika Girisch ◽  
Harald Bertram ◽  
...  
Keyword(s):  
Fontan Operation ◽  
Thromboembolic Complications ◽  
Cavopulmonary Anastomosis ◽  
Total Cavopulmonary Anastomosis

Abstract 19807: Pre-Superior Cavopulmonary Anastomosis Cardiac Catheterization at Altitude

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael V Di Maria ◽  
Thomas E Fagan ◽  
Neil Wilson ◽  
Max B Mitchell ◽  
David N Campbell ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Catheterization ◽  
Fontan Operation ◽  
Venous Pressure ◽  
Pulmonary Vasculature ◽  
Roc Curve Analysis ◽  
Cross Sectional ◽  
Poor Outcome ◽  
Cavopulmonary Anastomosis ◽  
Pulmonary Arterial

Introduction: Infants with single ventricle physiology typically undergo cardiac catheterization prior to superior cavopulmonary anastomosis (SCPA) to assess operative suitability. Predictors of poor outcome at sea level include elevated central venous pressure (CVP), transpulmonary gradient (TPG), pulmonary vascular resistance (PVR) and pulmonary artery (PA) size. Living at higher altitude has vasoconstrictive effects on the pulmonary vasculature, and a prior study suggested that higher PA pressure may predict worse outcomes. The goal of this study was to determine which elements of the pre-SCPA catheterization were useful in predicting successful Fontan operation at altitude. Methods: A retrospective review revealed 150 patients who underwent pre-SCPA catheterization over a 10-year period. Pre-SCPA catheterization data were abstracted and subjects were grouped by progression to Fontan vs. aborted palliation, heart transplant or death. Statistical analysis included Wilcoxon Rank Sum tests, uni-variable logistic regression and receiver operator characteristic (ROC) curve analysis. Results: Differences between groups at cardiac catheterization are summarized in Table 1. Logistic regression showed that larger PA diameter was protective; left PA: OR: 0.73, 95% CI: 0.6-0.9, p = 0.01; right PA: OR:0.73, 95% CI: 0.6-0.9, p = 0.02. ROC analysis defined thresholds for minimum left PA and right PA diameter of <4mm for poor outcome (area under the curve of 0.68 and 0.67, respectively). Conclusions: Our data suggest that pulmonary arterial size, more so than measured pressure or resistance, influences ability to achieve Fontan palliation at higher altitude. We hypothesize that this may be a feature of differences in pulmonary arterial growth. An alternative approach to evaluating pulmonary arterial morphology during palliation, such as cross-sectional imaging, may help optimize individual patient hemodynamics and provide better predictors of outcome.

The Estimation of Segmental Hepatic Venous Flow in Man

1964 ◽  
Vol 46 (5) ◽  
pp. 525-530 ◽  
Author(s):  
Roger Williams ◽  
D.S. Zimmon ◽  
Eileen Thompson ◽  
Sheila Sherlock
Keyword(s):  
Venous Flow ◽  
Hepatic Venous Flow
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