A quantitative analysis of hemodynamic effects of the right ventricle included in the circulation of the Fontan procedure.

Abstract

BACKGROUND Right heart hemodynamics were analyzed with a catheter-mounted velocity meter in seven patients after direct atrioventricular anastomosis for Fontan procedure (RV group) and were compared with those obtained in eight patients after direct atriopulmonary anastomosis (RA group). METHODS AND RESULTS In the RV group, cardiac output was 2.7 +/- 0.6 l/min/m2; mean right atrial and pulmonary artery pressures were both 13 +/- 3 mm Hg; mean pulmonary artery wedge pressure was 7 +/- 5 mm Hg; left ventricular end-diastolic volume, determined angiographically, was 129 +/- 40% of normal; and its ejection fraction was 0.50 +/- 0.09. In the RA group, data were similar to those of the RV group except that right heart pressure were lower in the RV group, which was related to the preoperative condition of the pulmonary circulation. In the RV group, the fraction of ventricular forward flow of the total forward flow in the main pulmonary artery ranged from 0.21 to 0.46 and was not correlated with cardiac output or with any other parameter. The backward flow into the inferior vena cava at ventricular systole was greater than the atrial flow in two patients in whom cardiac output was less than 2.2 l/min/m2, whereas caval backward flow at atrial contraction was greater than ventricular flow in the other five patients, of whom four had a cardiac output greater than 3.1 l/min/m2. CONCLUSIONS We conclude that the inclusion of right ventricle in the circulation of the Fontan procedure does not necessarily improve overall hemodynamics in most patients.

Ventricular energetics in Fontan circulation: Evaluation with a theoretical model

“…Table 1 summarizes values of Ees, Ea, SV and ventricular ejection fraction (EF) in each circulation. A value of 61% for EF is reasonable for the normal circulation and the 48% EF value obtained for the Fontan circulation agrees with previously reported EF values after Fontan operation, 20,22 supporting the validity of our estimates. The Ees of the Fontan circulation was lower than that of the normal circulation, whereas the Ea of the Fontan circulation was higher than that of the normal circulation.…”

“…15 Using normal values of myocardial mass in humans and Vo in the dog (90 g/m 2 and 10 mL/100 g myocardium, 16,17 respectively), Vo was estimated to be 9 mL/m 2 . For the Fontan circulation, because Ved after the Fontan procedure is shows 100–120% of normal 18–20 and myocardial mass is approximately 120% of normal, 19,21 Vo and Ved were assumed to be 11 mL/m 2 and 77 mL/m 2 , respectively. After the Fontan operation, Ea was determined according to the following analysis using an electrical analogy for the Fontan circulation ( Fig.…”

Molecular and physiological characterization of RV remodeling in a murine model of pulmonary stenosis

“…RV dysfunction is a common cause of long-term morbidity in many patients with congenital heart defects, especially those producing RV pressure overload (RVOT obstructions such as tetralogy of Fallot) and those with systemic right ventricles (e.g., hypoplastic left heart syndrome) (21,41,42). For many of these patients, despite incredible progress in surgical repair or palliation, long-term survival and quality of life will depend on our ability to preserve long-term RV function.…”

Complex Catheter-Based Structural Heart Reconstruction in a Patient With Tricuspid Atresia and Björk Palliative Conduit

“…It did not take into account that the hypoplastic right ventricle could grow in time because of the constant blood flow into it, and with the lack of a valve in the conduit, would result in an ever-increasing backward flow of blood in systole. Long-term results have shown that this conduit does not improve hemodynamic properties ( 2 ). Fortunately, patients palliated in this manner are uncommon nowadays because modern era palliation techniques with extracardiac or lateral tunnel Fontan circuits have become the methods of choice.…”