Acute effects of the ACE inhibitor enalaprilat on the pulmonary, cerebral and systemic blood flow and resistance after the bidirectional cavopulmonary connection

Lee, Kyong Jin; Yoo, Shi Joon; Holtby, Helen; Grant, Brian; Mroczek, Dariusz; Wong, Derek; Grosse-Wortmann, Lars; Benson, Leland N.; Chaturvedi, Rajiv

doi:10.1136/hrt.2011.225656

Cited by 27 publications

(11 citation statements)

References 35 publications

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“…In view of the importance of arterial pressure maintenance, the role of reducing R sys in improving CO is likely to be limited in Fontan patients. This is supported by previous clinical findings that ACEI did not significantly increase CO or improve exercise capacity in postoperative Fontan patients (39,44). Nevertheless, it has been speculated that reducing R sys using ACEI might be beneficial for patients with severe ventricular systolic dysfunction (68).…”

Section: Discussionsupporting

confidence: 77%

Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study

Liang

Senzaki

Kurishima

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study. Am J Physiol Heart Circ Physiol 307: H1056 -H1072, 2014. First published July 25, 2014 doi:10.1152/ajpheart.00245.2014The physiological limitations of the Fontan circulation have been extensively addressed in the literature. Many studies emphasized the importance of pulmonary vascular resistance in determining cardiac output (CO) but gave little attention to other cardiovascular properties that may play considerable roles as well. The present study was aimed to systemically investigate the effects of various cardiovascular properties on clinically relevant hemodynamic variables (e.g., CO and central venous pressure). To this aim, a computational modeling method was employed. The constructed models provided a useful tool for quantifying the hemodynamic effects of any cardiovascular property of interest by varying the corresponding model parameters in model-based simulations. Herein, the Fontan circulation was studied compared with a normal biventricular circulation so as to highlight the unique characteristics of the Fontan circulation. Based on a series of numerical experiments, it was found that 1) pulmonary vascular resistance, ventricular diastolic function, and systemic vascular compliance play a major role, while heart rate, ventricular contractility, and systemic vascular resistance play a secondary role in the regulation of CO in the Fontan circulation; 2) CO is nonlinearly related to any single cardiovascular property, with their relationship being simultaneously influenced by other cardiovascular properties; and 3) the stability of central venous pressure is significantly reduced in the Fontan circulation. The findings suggest that the hemodynamic performance of the Fontan circulation is codetermined by various cardiovascular properties and hence a full understanding of patientspecific cardiovascular conditions is necessary to optimize the treatment of Fontan patients.

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Section: Discussionsupporting

confidence: 77%

Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study

Liang

Senzaki

Kurishima

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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“…It was reported that intravenous ACEI significantly decreased Qp/Qs in patients with BDG circulation, according to measurement of pulmonary and systemic blood flows. 15 It is suggested, in short, that a decrease in SVR by vasodilator administration may have resulted in a slight decrease in the proportion of SPCF of aortic blood flow in the present study compared with the published data.…”

Section: Spcf In Bdg Circulationsupporting

confidence: 72%

Favorable Effects of Oxygen Inhalation in Patients After Bidirectional Glenn Procedure as Assessed by Cardiovascular Magnetic Resonance Flow Measurement

Ishikawa

Sagawa

et al. 2016

Circ J

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“…ACE inhibitors are often used in this complex circulation, but the effects of their vasodilatation are unclear. Work in children with bidirectional cavopulmonary shunts demonstrated that enalaprilat did not increase total cardiac output but redistributed flow to the lower body, with a concomitant decrease in arterial oxygen saturation 25. The authors concluded that it is difficult to increase cardiac output in these patients and ACE inhibitors should be used with caution in those with borderline aortic saturations.…”

Section: The Single Ventriclementioning

confidence: 97%

Congenital heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology

Burch

Dedieu

2012

Heart

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Acute effects of the ACE inhibitor enalaprilat on the pulmonary, cerebral and systemic blood flow and resistance after the bidirectional cavopulmonary connection

Cited by 27 publications

References 35 publications

Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study

Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study

Favorable Effects of Oxygen Inhalation in Patients After Bidirectional Glenn Procedure as Assessed by Cardiovascular Magnetic Resonance Flow Measurement

Congenital heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology

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