Changes in venous return parameters associated with univentricular Fontan circulations

Macé, Loı̈c; Dervanian, Patrice; Bourriez, Armand; Mazmanian, Guy-Michel; Lambert, Virginie; Losay, J; Neveux, Jean-Yves

doi:10.1152/ajpheart.2000.279.5.h2335

Cited by 42 publications

(37 citation statements)

References 37 publications

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“…However, the sustainability of this situation over a lifetime after surgery has been a source of intense speculation and research 2-15, 16, 28, 29. The question why some patients remain symptom free in the face of such abnormal circulatory physiology whilst others become edematous, develop protein losing enteropathy and succumb early to cardiac failure (failed Fontan) remains unclear but is of paramount importance for patient health 2-14,16…”

Section: Discussionmentioning

confidence: 99%

Peripheral Vascular Adaptation and Orthostatic Tolerance in Fontan Physiology

et al. 2009

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Background-The Fontan circulation is critically dependent on elevated venous pressures to sustain effective venous return. We hypothesized that chronically increased systemic venous pressures lead to adaptive changes in regional and peripheral vessels to maintain cardiac output, especially when patients are upright. Methods and Results-Nine post-Fontan procedure patients (aged 13 to 24 years) and 6 age-and sex-matched controls were compared with techniques to measure circulatory responses (peripheral and compartmental blood flow, venous capacity, and microvascular filtration). Parameters studied included strain-gauge plethysmography measures of peripheral circulatory function, regional blood volume distribution by impedance plethysmography, and head-up tilt testing. Important differences between Fontan patients and controls were seen in several vascular compartments: (1) Calf capacitance was lower (median, 3.5 versus 5.5 mL/100 mL tissue; Pϭ0.005), and resting venous pressure was higher (13.0 versus 10.5 mm Hg; Pϭ0.004); (2) higher leg arterial resistance was observed (32.1 versus 22.2; Pϭ0.03); (3) microvascular filtration pressures and threshold for edema were elevated; and (4)

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Section: Discussionmentioning

confidence: 99%

Peripheral Vascular Adaptation and Orthostatic Tolerance in Fontan Physiology

et al. 2009

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“…Recent quantitative investigations on univentricle circulation using lumped parameter models highlighted the importance of venous inflow parameters on cardiac output 33,34,39. Reasons behind the chronic venous compliance remodeling (up to 400%)26 and acute post-op venous blood volume shift are clarified through these models 39.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Performance of Stage-2 Univentricular Reconstruction: Glenn vs. Hemi-Fontan Templates

et al. 2008

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Flow structures, hemodynamics and the hydrodynamic surgical pathway resistances of the final stage functional single ventricle reconstruction, namely the total cavopulmonary connection (TCPC) anatomy, have been investigated extensively. However, the second stage surgical anatomy (i.e., bi-directional Glenn or hemi-Fontan template) has received little attention. We thus initiated a multi-faceted study, involving magnetic resonance imaging (MRI), phase contrast MRI, computational and experimental fluid dynamics methodologies, focused on the second stage of the procedure. Twenty three-dimensional computer and rapid prototype models of 2nd stage TCPC anatomies were created, including idealized parametric geometries (n = 6), patient-specific anatomies (n = 7), and their virtual surgery variant (n = 7). Results in patient-specific and idealized models showed that the Glenn connection template is hemodynamically more efficient with (83% p = 0.08 in patient-specific models and 66% in idealized models) lower power losses compared to hemi-Fontan template, respectively, due to its direct end-to-side anastomosis. Among the several secondary surgical geometrical features, stenosis at the SVC anastomosis or in pulmonary branches was found to be the most critical parameter in increasing the power loss. The pouch size and flare shape were found to be less significant. Compared to the third stage surgery the hydrodynamic resistance of the 2nd stage is considerably lower (both in idealized models and in anatomical models at MRI resting conditions) for both hemi- and Glenn templates. These results can impact the surgical design and planning of the staged TCPC reconstruction.

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“…The unique single-ventricle physiology of the Fontan circulation has been extensively addressed in the literature (29,33,42,49,68). A prevalent viewpoint is that CO in a Fontan circulation is determined predominantly by pulmonary vascular resistance rather than by other cardiovascular properties (e.g., ventricular contractility and peripheral vascular resistance) that are generally known as important factors in the control of CO in a biventricular circulation (29,42).…”

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confidence: 99%

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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Changes in venous return parameters associated with univentricular Fontan circulations

Cited by 42 publications

References 37 publications

Peripheral Vascular Adaptation and Orthostatic Tolerance in Fontan Physiology

Peripheral Vascular Adaptation and Orthostatic Tolerance in Fontan Physiology

Hemodynamic Performance of Stage-2 Univentricular Reconstruction: Glenn vs. Hemi-Fontan Templates

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

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