Peripheral venous pressure accurately predicts central venous pressure in the adult Fontan circulation

Tan, Weiyi; Small, Adam; Gallotti, Roberto; Moore, Jeremy P.; Aboulhosn, Jamil

doi:10.1016/j.ijcard.2020.11.007

Cited by 14 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lower PVP at peak exercise with ISDN could be associated with an important long-term bene t in reducing chronic end-organ injury. There is an excellent correlation between PVP and central venous pressure in the Fontan circulation [11,32]. Our group and others have shown the feasibility of measuring PVP and the association between both resting and peak PVP with clinical outcomes [10,26].…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Isosorbide DiNitrate Effect on Hemodynamic Profile, Liver Stiffness, and Exercise Tolerance in Fontan Circulation (The NEET Clinical Trial)

Bigelow

Riggs

Morales

et al. 2023

Preprint

View full text Add to dashboard Cite

Introduction: After Fontan operation, decreased venous capacitance and venoconstriction are adaptive mechanisms to maintain venous return and cardiac output. The consequent higher venous pressure may adversely impact end-organ function, exercise capacity and result in worse clinical outcomes. This pilot study evaluated the safety and effect of isosorbide dinitrate (ISDN), a venodilator, on exercise capacity, peripheral venous pressure (PVP), and liver stiffness in patients with Fontan circulation. Methods: In this prospective single-arm trial, 15 individuals with Fontan circulation were evaluated at baseline and after four weeks of therapeutic treatment with ISDN. Primary aims were to assess the safety of ISDN and the effect on maximal exercise (peak oxygen consumption, peak VO2). We also aimed to assess the effect of ISDN on ultrasound-assessed liver stiffness, markers of submaximal exercise, and PVP at rest and peak exercise. Repeated measures t-tests were used to assess change in variables of interest in response to ISDN. Results: Mean age was 23.5 ± 9.2 years (range 11.2-39.0 years), and 10/15 (67%) were male. There was no statistically significant change in peak VO2 (1401±428 to 1428±436 mL/min, p=0.128), but VO2 at the anaerobic threshold increased (1087 + 313 to 1115 + 302 mL/min, p= 0.03). ISDN was also associated with a lower peak exercise PVP (22.5 + 4.5 to 20.6 + 3.0 mmHg, p=0.015). Liver stiffness was lower with ISDN, though the difference was not statistically significant (2.3 + 0.4 to 2.1 + 0.5 m/s, p=0.079). Of the patients completing the trial, mild headache was common (67%), but there were no major adverse events. Conclusions: Treatment with ISDN for 4 weeks is well-tolerated in patients with a Fontan circulation. ISDN is associated with an increase in VO2 at anaerobic threshold, lower peak PVP, and a trend towards lower liver stiffness. Larger, longer studies will be necessary to define the impact of ISDN on clinical outcomes in the Fontan circulation. Clinical Trial Registration: URL: https//clinicaltrials.gov. Unique identifier: NCT04297241

show abstract

Section: Discussionmentioning

confidence: 95%

“…In the recent years, measuring peripheral venous pressure (PVP) was found to be practical and feasible with good correlation with central venous pressure post Fontan. PVP monitoring is also feasible in Fontan patients during exercise and is associated with relevant outcomes in patients with Fontan circulation [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Isosorbide DiNitrate Effect on Hemodynamic Profile, Liver Stiffness, and Exercise Tolerance in Fontan Circulation (The NEET Clinical Trial)

Bigelow

Riggs

Morales

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…The lower PVP at peak exercise with ISDN could be associated with an important long-term benefit in reducing chronic end-organ injury. There is an excellent correlation between PVP and CVP in the Fontan circulation [ 11 , 32 ]. Our group and others have shown the feasibility of measuring PVP and the association between both resting and peak PVP with clinical outcomes [ 10 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Isosorbide DiNitrate Effect on Hemodynamic Profile, Liver Stiffness, and Exercise Tolerance in Fontan Circulation (The NEET Clinical Trial)

et al. 2023

View full text Add to dashboard Cite

After Fontan operation, decreased venous capacitance and venoconstriction are adaptive mechanisms to maintain venous return and cardiac output. The consequent higher venous pressure may adversely impact end-organ function, exercise capacity and result in worse clinical outcomes. This pilot study evaluated the safety and effect of isosorbide dinitrate (ISDN), a venodilator, on exercise capacity, peripheral venous pressure (PVP), and liver stiffness in patients with Fontan circulation. In this prospective single-arm trial, 15 individuals with Fontan circulation were evaluated at baseline and after 4 weeks of therapeutic treatment with ISDN. Primary aims were to assess the safety of ISDN and the effect on maximal exercise. We also aimed to evaluate the effect of ISDN on ultrasound-assessed liver stiffness, markers of submaximal exercise, and PVP at rest and peak exercise. Repeated measures t -tests were used to assess change in variables of interest in response to ISDN. Mean age was 23.5 ± 9.2 years (range 11.2–39.0 years), and 10/15 (67%) were male. There was no statistically significant change in peak VO 2 (1401 ± 428 to 1428 ± 436 mL/min, p = 0.128), but VO 2 at the anaerobic threshold increased (1087 ± 313 to 1115 ± 302 mL/min, p = 0.03). ISDN was also associated with a lower peak exercise PVP (22.5 ± 4.5 to 20.6 ± 3.0 mmHg, p = 0.015). Liver stiffness was lower with ISDN, though the difference was not statistically significant (2.3 ± 0.4 to 2.1 ± 0.5 m/s, p = 0.079). Of the patients completing the trial, mild headache was common (67%), but there were no major adverse events. Treatment with ISDN for 4 weeks is well-tolerated in patients with a Fontan circulation. ISDN is associated with an increase in VO 2 at anaerobic threshold, lower peak PVP, and a trend toward lower liver stiffness. Larger, longer duration studies will be necessary to define the impact of ISDN on clinical outcomes in the Fontan circulation. Clinical Trial Registration: URL: https://clinicaltrials.gov . Unique identifier: NCT04297241. Supplementary Information The online version contains supplementary material available at 10.1007/s00246-023-03156-3.

show abstract

“…Prior work identified a strong correlation between peripheral and central venous pressure in children, 19 and recently, peripheral venous pressure was proved as a good predictor of central venous pressure in the adult population of Fontan patients. 20 All patients at our institution routinely undergo cardiac magnetic resonance examination and peripheral venous pressure measurements prior to the total cavopulmonary connection operation, 1 year after that, and 1-2 times after this throughout childhood and adolescence (see Fig 2). The optimal timing and frequency of posttotal cavopulmonary connection cardiac magnetic resonance studies remain unclear, 21 though the American Heart Association's scientific statement on evaluating a child or adult with a Fontan circulation suggests cardiac magnetic resonance once every 2-3 years.…”

Section: Discussionmentioning

confidence: 99%

Institutional transition from invasive to non-invasive imaging in children with univentricular heart defects: safety and cost savings

et al. 2022

View full text Add to dashboard Cite

Objectives:Patients with univentricular heart defects require lifelong imaging surveillance. Recent advances in non-invasive imaging have enabled replacing these patients’ routine catheterisation. Our objective was to describe the safety and cost savings of transition of a tertiary care children’s hospital from routine invasive to routine non-invasive imaging of low-risk patients with univentricular heart defects.Methods:This single-centre cohort study consists of 1) a retrospective analysis of the transition from cardiac catheterisation (n = 21) to CT angiography (n = 20) before bidirectional Glenn operation and 2) a prospective study (n = 89) describing cardiac magnetic resonance before and after the total cavopulmonary connection in low-risk patients with univentricular heart defects.Results:Pre-Glenn: The total length of CT angiography was markedly shorter compared to the catheterisation: 30 min (range: 20–60) and 125 min (range: 70–220), respectively (p < 0.001). Catheterisation used more iodine contrast agents than CT angiography, 19 ± 3.9 ml, and 10 ± 2.4 ml, respectively (p < 0.001). Controlled ventilation was used for all catheterised and 3 (15%) CT angiography patients (p < 0.001). No complications occurred during CT angiography, while they emerged in 19% (4/21) catheterisation cases (p < 0.001). CT angiography and catheterisation showed no significant difference in the radiation exposure.Pre-/post-total cavopulmonary connection: All cardiac magnetic resonance studies were successful, and no complications occurred. In 60% of the cardiac magnetic resonance (53/89), no sedation was performed, and peripheral venous pressure was measured in all cases. Cost analysis suggests that moving to non-invasive imaging yielded cost savings of at least €2500–4000 per patient.Conclusion:Transition from routine invasive to routine non-invasive pre-and post-operative imaging is safely achievable with cost savings.

show abstract

Peripheral venous pressure accurately predicts central venous pressure in the adult Fontan circulation

Cited by 14 publications

References 16 publications

Isosorbide DiNitrate Effect on Hemodynamic Profile, Liver Stiffness, and Exercise Tolerance in Fontan Circulation (The NEET Clinical Trial)

Isosorbide DiNitrate Effect on Hemodynamic Profile, Liver Stiffness, and Exercise Tolerance in Fontan Circulation (The NEET Clinical Trial)

Isosorbide DiNitrate Effect on Hemodynamic Profile, Liver Stiffness, and Exercise Tolerance in Fontan Circulation (The NEET Clinical Trial)

Institutional transition from invasive to non-invasive imaging in children with univentricular heart defects: safety and cost savings

Contact Info

Product

Resources

About