Characteristics of Doppler myocardial echocardiography in patients with tricuspid atresia after total cavopulmonary connection with preserved systolic ventricular function

Eicken, Andreas; Petzuch, Kurt; Marek, Jan; Vogel, Michael; Hager, Alfred; Vogt, Manfred; Škovránek, J; Busch, Raymonde; Schreiberd, Christian; Hess, John

doi:10.1016/j.ijcard.2006.02.019

Cited by 19 publications

(8 citation statements)

References 36 publications

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“…These studies support the hypothesis of diastolic inflow obstruction [11,16]. Recently, Giardini et al [14] showed that a single dose of sildenafil acutely improved exercise performance.…”

Section: Discussionsupporting

confidence: 57%

Increase in N-Terminus-Pro-B-Type Natriuretic Peptide During Exercise of Patients With Univentricular Heart After a Total Cavopulmonary Connection

2012

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“…These studies support the hypothesis of diastolic inflow obstruction [11,16]. Recently, Giardini et al [14] showed that a single dose of sildenafil acutely improved exercise performance.…”

Section: Discussionsupporting

confidence: 57%

Increase in N-Terminus-Pro-B-Type Natriuretic Peptide During Exercise of Patients With Univentricular Heart After a Total Cavopulmonary Connection

2012

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“…Although children and adults with “Fontan failure” exhibit classic features of congestive heart failure (increased tissue/organ water, decreased tissue/organ perfusion), the underlying cause is not primary myocardial dysfunction. The ventricular (diastolic) dysfunction observed in Fontan patients may be to a large extent attributable to chronically reduced filling [15–17]. …”

Section: Discussionmentioning

confidence: 99%

Cavopulmonary assist for the univentricular Fontan circulation: von Kármán viscous impeller pump

Rodefeld

Coats

Fisher

et al. 2010

The Journal of Thoracic and Cardiovascular Surgery

110

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Objectives In a univentricular Fontan circulation, modest augmentation of existing cavopulmonary pressure head (2–5 mmHg) would reduce systemic venous pressure, increase ventricular filling, and thus, substantially improve circulatory status. An ideal means of providing mechanical cavopulmonary support does not exist. We hypothesized that a viscous impeller pump, based on the von Kármán viscous pump principle, is optimal for this role. Methods A 3-dimensional computational model of the total cavopulmonary connection was created. The impeller was represented as a smooth 2-sided conical actuator disk with rotation in the vena caval axis. Flow was modeled under 3 conditions: 1) passive flow with no disc; 2) passive flow with a non-rotating disk, and 3) induced flow with disc rotation (0–5K rpm). Flow patterns and hydraulic performance were examined for each case. Hydraulic performance for a vaned impeller was assessed by measuring pressure rise and induced flow over 0–7K rpm in a laboratory mock loop. Results A nonrotating actuator disc stabilizes cavopulmonary flow, reducing power loss by 88%. Disk rotation (from baseline dynamic flow of 4.4 L/min) resulted in a pressure rise of 0.03 mmHg. A further increase of pressure of 5–20 mmHg and 0–5 L/min flow were obtained with a vaned impeller at 0–7K rpm in a laboratory mock loop. Conclusions A single viscous impeller pump stabilizes and augments cavopulmonary flow in 4 directions, in the desired pressure range, without venous pathway obstruction. It applies to the existing staged protocol as a temporary bridge-to-recovery or –transplant in established univentricular Fontan circulations. It may also enable compressed palliation of single ventricle without need for intermediary surgical staging or use of a systemic-to-pulmonary arterial shunt.

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“…In late follow up, systolic dysfunction is preserved in 70% [10]. The ventricular dysfunction observed is characteristically diastolic, likely secondary to chronic preload deprivation superimposed on a noncompliant ventricle [13]. Studies are also finding no benefit of intermediate staging with regard to late ventricular function and functional status [10], casting doubt on clinical assumptions that interim staging is beneficial with respect to late ventricular function by an earlier transition to a less volume loaded state.…”

Section: Interim Staged Palliation - Pathophysiology and Paradoxmentioning

confidence: 99%

Cavopulmonary Assist: (Em)powering the Univentricular Fontan Circulation

Rodefeld

Frankel

Giridharan

2011

Seminars in Thoracic and Cardiovascular Surgery: Pediatric Card

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Since the Fontan/Kreutzer procedure was introduced, evolutionary clinical advances via a staged surgical reconstructive approach have markedly improved outcomes for patients with functional single ventricle. However, significant challenges remain. Early stage mortality risk seems impenetrable. Serious morbidities -construed as immutable consequences of palliation -have hardly been addressed. Late functional status is increasingly linked to pathophysiologic consequences of prior staged procedures. As more single ventricle patients survive into adulthood, Fontan failure is emerging as an intractable problem for which there is no targeted therapy. Incremental solutions to address these ongoing problems have not had a measurable impact. Therefore, a fundamental reconsideration of the overall approach is reasonable and warranted. The ability to provide a modest pressure boost (2-6 mmHg) to existing blood flow at the total cavopulmonary connection can effectively restore more stable biventricular status. This would impact not only treatment of late Fontan failure, but also facilitate early surgical repair. A realistic means to provide such a pressure boost has never been apparent. Recent advances are beginning to unravel the unique challenges which must be addressed to realize this goal, with promise to open single ventricle palliation to new therapeutic vistas. Keywordsuniventricular Fontan circulation; cavopulmonary assist; mechanical circulatory support © 2011 Elsevier Inc. All rights reserved.Address for correspondence: Mark Rodefeld MD, Associate Professor of Surgery, Department of Surgery, Indiana University School of Medicine, Emerson Hall 215, 545 Barnhill Drive, Indianapolis, IN 46202. Tel: 317-274-7728; Fax: 317-274-2940; rodefeld@iupui.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. . It was known then that a pressure gradient of only 6 mmHg was needed to propel blood from the pulmonary artery through the lungs [3]. From these reports, it can be inferred that complete bypass of the right heart as a primary, direct intervention was nearly accomplished. With incorporation of the right atrium as a low energy right-sided power source, it ultimately was. Using a right-sided power source to supplement a univentricular Fontan circulation is highly compelling: it would biventricularize it toward more stable 2-ventricle physiology. This could serve not only to stabilize an existing Fontan circulation, but also serve in direct Fontan conversion as a facilitator for stable systemic transition to an unsupported Fontan. Presented at STS/AATSBecause a safe and reliabl...

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Characteristics of Doppler myocardial echocardiography in patients with tricuspid atresia after total cavopulmonary connection with preserved systolic ventricular function

Cited by 19 publications

References 36 publications

Increase in N-Terminus-Pro-B-Type Natriuretic Peptide During Exercise of Patients With Univentricular Heart After a Total Cavopulmonary Connection

Increase in N-Terminus-Pro-B-Type Natriuretic Peptide During Exercise of Patients With Univentricular Heart After a Total Cavopulmonary Connection

Cavopulmonary assist for the univentricular Fontan circulation: von Kármán viscous impeller pump

Cavopulmonary Assist: (Em)powering the Univentricular Fontan Circulation

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