scholarly journals Use of echocardiographic parameters of longitudinal mechanics to estimate diastolic function of systemic ventricle in patients after fontan operation

2020 ◽  
Vol 37 (2) ◽  
pp. 65-82
Author(s):  
Yu. S. Sinelnikov ◽  
T. V. Matanovskaya ◽  
S. A. Orekhov
Keyword(s):  
Cardiac Output ◽  
Strain Rate ◽  
Longitudinal Strain ◽  
Fontan Operation ◽  
Total Cavopulmonary Connection ◽  
Hemodynamic Parameters ◽  
Echocardiographic Parameters ◽  
Single Atrium ◽  
Systemic Ventricle ◽  
Cavopulmonary Connection

Objective. To study the possibilities of using echocardiographic parameters of longitudinal mechanics to assess the diastolic function of the systemic ventricle (SV) in patients after Fontan operation. Material and methods. We examined 29 children aged 8,6 3,16 years with a functionally single ventricle of the heart after performing a total cavopulmonary connection with fenestration of extracardiac conduit. By computed tomography there were evaluated: myocardial mass index (MMI) SV, ejection fraction (EF) SV, cardiac output (CO) SV, cardiac index (CI) SV. In addition to conventional echocardiographic (Echo) parameters, we also studied: diastolic velocity parameters of the longitudinal mechanics of the SV during the early rapid filling phase (SR E), in the phase of late diastolic filling (SR A), the ratio of the peaks of the strain rate (SR E/SR A), the stiffness index of a functionally single atrium, the atrial strain in conduit phase (AS cd), reservoir (ASr), and in the contractile phase (AS ct). Results. Reduced values of the SI, CO and CI SV, an increase in MMI SV, normal values of EF SV. The parameters of the longitudinal diastolic strain rate in the early and late filling phases of e SV showed a direct significant correlation with SI, CO and CI SV and inverse correlation with E/e '. Parameters of longitudinal strain of the functionally single atrium in all phases were reduced, they all correlated with E / e, SR E / SR A, MMI SV, SI, CO and CI SV. There was no statistically significant relationship between the parameters of the longitudinal function of the atrium in all phases and atrial stiffness with sex and body surface area. Conclusions. 1. The parameters of the longitudinal diastolic strain rate can be used to identify the diastolic dysfunction of the systemic ventricle in children after Fontan operation. 2. The hemodynamic parameters of the systemic ventricle (stroke index, cardiac output, cardiac index) determine the parameters of its diastolic mechanics. 3. The reservoir, conduit, and contractile atrial function in patients after total cavopulmonary connection are associated with both characteristics of diastolic longitudinal strain rate and hemodynamic parameters of systemic ventricle.

Early postoperative extubation of unstable patients following total cavopulmonary connection: impact on circulation and outcome

2016 ◽  
Vol 27 (5) ◽  
pp. 860-869 ◽  
Author(s):  
Stanimir Georgiev ◽  
Gunter Balling ◽  
Bettina Ruf ◽  
Kilian Ackermann ◽  
Jelena P. von Ohain ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Fontan Operation ◽  
Management Tool ◽  
Total Cavopulmonary Connection ◽  
Early Extubation ◽  
Respective Group ◽  
Group 2 ◽  
Cavopulmonary Connection ◽  
Group 1 ◽  
Sustained Increase

AbstractObjectivesWe aimed to investigate whether early postoperative extubation following the Fontan operation is universally feasible and can be used as a management tool in unstable patients.MethodsAll patients undergoing the Fontan operation in our centre between 2004 and 2013 (n=253) were analysed. Until 2008, patients were extubated according to standard criteria and comprised group 1. Group 2 included all patients presenting after 2009, when early extubation was always aimed regardless of the haemodynamic status. Patients who exceeded the 75th percentiles for volume requirements and inotrope scores for the respective group were defined as unstable. Comparisons of outcomes between groups and subgroups and analysis of the changes in haemodynamic and treatment parameters with extubation in unstable patients after 2009 were performed.ResultsCompared with group 1, patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.50), and needed less volume (p=0.01). In group 2, the unstable patients were not ventilated for longer durations (p=0.19), but had higher re-intubation rates (p=0.03) than the stable patients. Compared with the unstable patients from group 1, the unstable patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.66), and needed less volume (p=0.006). There was a significant acute and sustained increase in mean arterial pressure with extubation and a parallel reduction in volume requirements and inotrope scores in the unstable patients from group 2.ConclusionsTimely extubation is universally applicable following the Fontan operation. Early postoperative extubation can be valuable for improving Fontan haemodynamics.

Reference values for two-dimensional myocardial strain echocardiography of the left ventricle in healthy children

2019 ◽  
Vol 29 (3) ◽  
pp. 325-337
Author(s):  
Laurens P. Koopman ◽  
Bas Rebel ◽  
Devi Gnanam ◽  
Mirthe E. Menting ◽  
Willem A. Helbing ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Strain Rate ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Healthy Children ◽  
Deformation Parameters ◽  
Strain And Strain Rate ◽  
Echocardiographic Parameters

AbstractBackgroundMyocardial deformation by speckle tracking echocardiography provides additional information on left ventricular function. Values of myocardial deformation (strain and strain rate) depend on the type of ultrasound machine and software that is used. Normative values for QLAB (Philips) are scarce, especially for children. It is important to evaluate the influence of age and body size on myocardial deformation parameters, since anthropometrics strongly influence many standard echocardiographic parameters. The aim of this study was to provide comprehensive normal values for myocardial deformation of the left ventricle using a Philips platform and to evaluate the association with anthropometric and standard echocardiographic parameters.MethodsHealthy children between 1 and 18 years of age were prospectively examined using a standard echocardiographic protocol. Short-axis and apical four-chamber, two-chamber, and three-chamber views were used to measure peak systolic circumferential and longitudinal strain and systolic and early diastolic strain rate of the left ventricle using dedicated software.ResultsA total of 103 children were included with a mean age of 10.8 and inter-quartile range 7.3–14.3 years. Global circumferential strain values (±SD) were −24.2±3.5% at basal, −25.8±3.5% at papillary muscle, and −31.9±6.2% at apex levels. Global left ventricular longitudinal strain values were −20.6±2.6% in apical four-chamber view, −20.9±2.7% in apical two-chamber, and −21.0 ±2.7% in apical three-chamber. Age was associated with longitudinal strain, longitudinal systolic and early diastolic strain rate, but not with circumferential strain.ConclusionsNormal values for left ventricular deformation parameters in children are obtained using a Philips platform. Age partly explains normal variation of strain and strain rate.

scholarly journals Myocardial Perfusion in Hypoplastic Left Heart Syndrome: Risk Factors for the Right Ventricular Microcirculation

2021 ◽  
Author(s):  
Carsten Rickers ◽  
Philip Wegner ◽  
Michael Silberbach ◽  
Erin Madriago ◽  
Dominik Daniel Gabbert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Late Gadolinium Enhancement ◽  
Right Ventricular ◽  
Coronary Microcirculation ◽  
Total Cavopulmonary Connection ◽  
Gadolinium Enhancement ◽  
Coronary Conductance ◽  
Systemic Ventricle ◽  
Left Heart Syndrome ◽  
Cavopulmonary Connection

Background: The status of the systemic right ventricular coronary microcirculation in hypoplastic left heart syndrome (HLHS) is largely unknown. It is presumed that the systemic right ventricle’s coronary microcirculation exhibits unique pathophysiological characteristics of HLHS in Fontan circulation. The present study sought to quantify myocardial blood flow by cardiac magnetic resonance imaging and evaluate the determinants of microvascular coronary dysfunction and myocardial ischemia in HLHS. Methods: One hundred nineteen HLHS patients (median age, 4.80 years) and 34 healthy volunteers (median age, 5.50 years) underwent follow-up cardiac magnetic resonance imaging ≈1.8 years after total cavopulmonary connection. Right ventricle volumes and function, myocardial perfusion, diffuse fibrosis, and late gadolinium enhancement were assessed in 4 anatomic HLHS subtypes. Myocardial blood flow (MBF) was quantified at rest and during adenosine-induced hyperemia. Coronary conductance was estimated from MBF at rest and catheter-based measurements of mean aortic pressure (n=99). Results: Hyperemic MBF in the systemic ventricle was lower in HLHS compared with controls (1.89±0.57 versus 2.70±0.84 mL/g per min; P <0.001), while MBF at rest normalized by the rate-pressure product, was similar (1.25±0.36 versus 1.19±0.33; P =0.446). Independent risk factors for a reduced hyperemic MBF were an HLHS subtype with mitral stenosis and aortic atresia ( P =0.017), late gadolinium enhancement ( P =0.042), right ventricular diastolic dysfunction ( P =0.005), and increasing age at total cavopulmonary connection ( P =0.022). The coronary conductance correlated negatively with systemic blood oxygen saturation (r, −0.29; P =0.02). The frequency of late gadolinium enhancement increased with age at total cavopulmonary connection ( P =0.014). Conclusions: The coronary microcirculation of the systemic ventricle in young HLHS patients shows significant differences compared with controls. These hypothesis-generating findings on HLHS-specific risk factors for microvascular dysfunction suggest a potential benefit from early relief of frank cyanosis by total cavopulmonary connection.

Non-invasive cardiac output monitoring during catheter interventions in patients with cavopulmonary circulations

2013 ◽  
Vol 24 (3) ◽  
pp. 417-421 ◽  
Author(s):  
Patrick Michael Emmet Noonan ◽  
Sangeetha Viswanathan ◽  
Amy Chambers ◽  
Oliver Stumper
Keyword(s):  
Cardiac Output ◽  
Left Pulmonary Artery ◽  
Cardiac Output Monitoring ◽  
Total Cavopulmonary Connection ◽  
Non Invasive ◽  
Median Increase ◽  
Complex Patients ◽  
In Series ◽  
Output Monitoring ◽  
Cavopulmonary Connection

AbstractIntroduction: Functionally univentricular hearts palliated with superior or total cavopulmonary connection result in circulations in series. The absence of a pre-pulmonary pump means that cardiac output is more difficult to adjust and control. Continuous monitoring of cardiac output is crucial during cardiac catheter interventions and can provide new insights into the complex physiology of these lesions. Materials and methods: The Icon® cardiac output monitor was used to study the changes in cardiac output during catheter interventions in 15 patients (median age: 6.1 years, range: 4.8–15.3 years; median weight: 18.5 kg, range: 15–63 kg) with cavopulmonary circulations. A total of 19 interventions were undertaken in these patients and the observed changes in cardiac output were recorded and analysed. Results: Cardiac output was increased with creation of stent fenestrations after total cavopulmonary connection (median increase of 22.2, range: 6.7%–28.6%) and also with drainage of significant pleural effusions (16.7% increase). Cardiac output was decreased with complete or partial occlusion of fenestrations (median decrease of 10.6, range: 7.1%–13.4%). There was a consistent increase in cardiac output with stenting of obstructive left pulmonary artery lesions (median increase of 7.7, range: 5%–14.3%, p = 0.007). Conclusions: Icon® provides a novel technique for the continuous, non-invasive monitoring of cardiac output. It provides a further adjunct for monitoring of physiologically complex patients during catheter interventions. These results are consistent with previously reported series involving manipulation of fenestrations. This is the first report identifying an increase in cardiac output with stenting of obstructive pulmonary arterial lesions.

Hemostatic Changes following the Modified Fontan Operation (Total Cavopulmonary Connection)

2000 ◽  
Vol 83 (05) ◽  
pp. 678-682 ◽  
Author(s):  
Martin Ries ◽  
Michael Hofbeck ◽  
Gernot Buheitel ◽  
Helmut Singer ◽  
Jens Klinge ◽  
...  
Keyword(s):  
Fontan Operation ◽  
Protein S ◽  
Coagulation System ◽  
Clot Lysis ◽  
Total Cavopulmonary Connection ◽  
Thrombotic Risk ◽  
Normal Ranges ◽  
Thrombin Activation ◽  
Cavopulmonary Connection

SummaryThromboembolism is a serious complication after Fontan operation, which may be caused by alterations of the coagulation system. We therefore investigated pro- and anticoagulant factors in 20 patients aged 4 to 21 years, 4 to 63 months following total cavopulmonary connection. Furthermore we compared markers of thrombin activation and fibrinolysis and in vitro clotting and clot-lysis to age-matched healthy subjects.Compared to results of age-matched controls, the Fontan operated individuals had significant decreases in levels of protein C (0.88 U/ml in controls, 0.67 U/ml in patients; p <0.001) and protein S (1.05 in controls, 0.93 U/ml in patients; p <0.05). Moreover, half of the patients had high values of FVIII (>1.5 IU/ml), which are associated with an increased thrombotic risk. These changes may result in enhanced generation of thrombin and plasmin, indicated by our finding of increased thrombin-antithrombin III (TAT) and plasmin-antiplasmin (PAP) levels and a similar trend in prothrombin fragments F1+2. Clot lysis tests, global coagulation tests, red blood cell count, liver enzymes AST, ALT, but not GGT, were generally within the normal ranges.

Conversion of the modified Fontan operation to total cavopulmonary connection: a treatment for protein-losing enteropathy

1997 ◽  
Vol 7 (3) ◽  
pp. 344-346 ◽  
Author(s):  
Gerd Stafanger ◽  
Gösta Pettersson ◽  
Joes Ramsøe Jacobsen
Keyword(s):  
Fontan Operation ◽  
Tricuspid Atresia ◽  
Total Cavopulmonary Connection ◽  
Protein Losing Enteropathy ◽  
Cavopulmonary Connection ◽  
Modified Fontan Operation

AbstractWe describe a patient with tricuspid atresia who, after a Fontan operation three years earlier, presented with severe protein-losing enteropathy. After conversion to a cavopulmonary connection, the symptoms regressed and substitution with albumin and immunoglobulin was no longer required.

Formation of thrombus and thromboembolism after the bidirectional Glenn anastomosis, total cavopulmonary connection and the Fontan operation

1998 ◽  
Vol 8 (2) ◽  
pp. 211-216 ◽  
Author(s):  
Katarina Hanséus ◽  
Gudrun Björkhem ◽  
Peeter Jögi ◽  
Sven-Erik Sonesson
Keyword(s):  
Clinical Characteristics ◽  
Fontan Procedure ◽  
Fontan Operation ◽  
Significant Risk ◽  
Sudden Onset ◽  
Pulmonary Trunk ◽  
Total Cavopulmonary Connection ◽  
Cerebrovascular Accidents ◽  
Bidirectional Glenn ◽  
Cavopulmonary Connection

AbstractAlthough patients undergoing surgery with the Fontan procedure or its modifications are increasingly recognised to be at risk for thromboembolism, further knowledge is needed to minimise this complication and its sequels. To address this issue, we reviewed 100 patients operated with the Fontan procedure, the bidirectional Glenn anastomosis and/or the total cavopulmonary connection to describe our incidence and clinical characteristics of postoperative formation of thrombus. Symptomatic thrombosis or cerebrovascular accidents were found in 5 patients. Asymptomatic thrombus were found in another 5 patients. Three patients had venous thrombi. In 6 patients the thrombosis was found on the arterial side. In all these cases, the thrombus was located in the stump of the divided pulmonary trunk. In 3 of these patients, sudden onset of hemiparesis preceded the diagnosis of the thrombus while the remaining 3 patients were asymptomatic. In 3 cases, the formation of thrombus in the stump of the divided pulmonary trunk occurred after a bidirectional Glenn anastomosis. One patient developed severe neurological symptoms 2 months after a total cavopulmonary connection. No thrombus was found, but the patient had a small right-to-left shunt and embolization could not be excluded. The incidence of thrombosis after Fontan-type surgery in this study is 10%. Although not all episodes of thrombosis are symptomatic, there is a significant risk of severe sequels due to embolization to the pulmonary or cerebral circulations. The stump of the divided pulmonary trunk is one of the main sites for intracardiac formation of thrombus, even after a bidirectional Glenn anastomosis.

Theoretical analysis of rest and exercise hemodynamics in patients with total cavopulmonary connection

2002 ◽  
Vol 282 (3) ◽  
pp. H1018-H1034 ◽  
Author(s):  
Elisa Magosso ◽  
Silvio Cavalcanti ◽  
Mauro Ursino
Keyword(s):  
Cardiac Output ◽  
Venous Return ◽  
Poor Response ◽  
Intrathoracic Pressure ◽  
Systemic Arterial Pressure ◽  
Regulatory Mechanisms ◽  
Total Cavopulmonary Connection ◽  
The Right ◽  
The Impact ◽  
Cavopulmonary Connection

The objective of this study was to determine the impact of a total cavopulmonary connection on the main hemodynamic quantities, both at rest and during exercise, when compared with normal biventricular circulation. The analysis was performed by means of a mathematical model of the cardiovascular system. The model incorporates the main parameters of systemic and pulmonary circulation, the pulsating heart, and the action of arterial and cardiopulmonary baroreflex mechanisms. Furthermore, the effect of changes in intrathoracic pressure on venous return is also incorporated. Finally, the response to moderate dynamic exercise is simulated, including the effect of a central command, local metabolic vasodilation, and the “muscle pump” mechanism. Simulations of resting conditions indicate that the action of baroreflex regulatory mechanisms alone can only partially compensate for the absence of the right heart. Cardiac output and mean systemic arterial pressure at rest show a large decrease compared with the normal subject. More acceptable hemodynamic quantity values are obtained by combining the action of regulatory mechanisms with a chronic change in parameters affecting mean filling pressure. With such changes assumed, simulations of the response to moderate exercise show that univentricular circulation exhibits a poor capacity to increase cardiac output and to sustain aerobic metabolism, especially when the oxygen consumption rate is increased above 1.2–1.3 l/min. The model ascribes the poor response to exercise in these patients to the incapacity to sustain venous return caused by the high resistance to venous return and/or to exhaustion of volume compensation reserve.

Valveless pump models that laid a false but fortuitous trail on the way towards the total cavopulmonary connection

2005 ◽  
Vol 15 (S3) ◽  
pp. 74-79 ◽  
Author(s):  
Philip J. Kilner
Keyword(s):  
Right Atrium ◽  
Fontan Operation ◽  
Venous Pressure ◽  
Fontan Circulation ◽  
Right Atrial ◽  
Total Cavopulmonary Connection ◽  
Valveless Pump ◽  
Cavopulmonary Connection ◽  
The Way

When Fontan and Baudet devised what has become known as the Fontan operation, they understandably assumed that inflow and outflow valves should be included to achieve a pump-like action of the subpulmonary right atrial cavity. Over the following years, however, it became apparent that valves did not function satisfactorily in this situation. Worse, the implanted valves had a tendency to become obstructive, which often lead to critical elevation of the already raised systemic venous pressure. Surgeons gradually realised that the outcomes of surgery designed to create the Fontan circulation were likely to be better without inclusion of valves in the subpulmonary right atrium, and they stopped putting them in.

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