Subdiaphragmatic venous hemodynamics in the Fontan circulation

Hsia, Tain‐Yen; Khambadkone, Sachin; Deanfield, John; Taylor, J F; Migliavacca, Francesco; Leval, Marc R. de

doi:10.1067/mtc.2001.112527

Cited by 88 publications

(98 citation statements)

References 37 publications

(62 reference statements)

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“…However, in a small study, hepatic wedge pressures were not able to estimate portal vascular disease in Fontan patients with congestive hepatopathy and sinusoidal dilatation. 143 In patients with chronically elevated venous pressures, a history of esophageal varices, other features of portal hypertension, or a history of hepatitis B, a liver biopsy and histologic evaluation for cirrhosis and determination of hepatic venous wedge pressure are appropriate. The presence of a normal hepatic venous wedge pressure and normal synthetic liver function suggests that these patients should not be turned down for transplantation on the basis of liver disease alone.…”

Section: Systemic Venous Anomalies In Patients With Situs Inversus Ormentioning

confidence: 99%

Transplantation and Mechanical Circulatory Support in Congenital Heart Disease

Ross¹,

Law²,

Book³

et al. 2016

Circulation

123

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Section: Systemic Venous Anomalies In Patients With Situs Inversus Ormentioning

confidence: 99%

Transplantation and Mechanical Circulatory Support in Congenital Heart Disease

Ross¹,

Law²,

Book³

et al. 2016

Circulation

123

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“…Although the Fontan surgical approach results in a stable physiology, there are attendant circulatory disadvantages, including elevated central venous pressures, 10 reduced ventricular filling, 11,12 and overall decreased cardiac output. 13 During exertion, these shortcomings are intensified.…”

Section: Discussionmentioning

confidence: 99%

Older Age at Completion of Fontan Procedure Is Associated with Improved Percentage of Predicted Maximum Oxygen Uptake

Bolin¹,

Maskatia²,

Tate³

et al. 2015

Texas Heart Institute Journal

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4 More recently, studies have shown that decreased exercise performance is associated with an increased risk of early death.5,6 Exercise stress test data might then uncover circulatory limitations not seen in the at-rest patient. We reviewed our institution's experience and sought to determine the association between a patient's age at performance of the Fontan procedure and his or her aerobic performance, as measured by the percentage of predicted maximum oxygen consumption (Vo 2 ). We especially focused on those patients who had been treated in accordance with the current strategy of staged single-ventricle palliation, in which a superior cavopulmonary connection (ScPc) precedes the Fontan procedure. Patients and MethodsIn this retrospective clinical study, we reviewed the cases of all Fontan patients who had undergone exercise testing at our center from April 2003 through March 2011. Patient demographics (age and sex) and clinical characteristics were obtained from our cardiology database. The age of each patient at the Fontan operation was also noted. The single-ventricle anatomy type (for example, morphologic right ventricle), the Fontan type (lateral tunnel or extracardiac conduit), and the presence of a fenestration at the time of the Fontan procedure and at the time of exercise testing were documented. Pacemaker dependency was also noted. In order to investigate a group palliated in accordance with current surgical strategy, patients were excluded if they had undergone a single-stage Fontan or a superior cavopulmonary anastomosis at an age older than one year. Patients were also excluded if they had a respiratory exchange ratio of less than 1, or a pacemaker at the time of exercise testing. Approval for this

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“…This system allowed us to accurately set the flow splits to simulate physiological (LHV/MHV/RHV: 0.4/0.4/0.2) and pathological flow rates (LHV/MHV/RHV: 0.3/0.4/0.2) reported in literature. [27][28][29]48,69,72 The experimental flow conditions are tabulated in Table 1. These flow conditions are labeled ''healthy'' and ''pathological'' according to the clinical diagnoses of pediatric patients.…”

Section: In Vitro Flow Loopmentioning

confidence: 99%

Hemodynamics of the Hepatic Venous Three-Vessel Confluences Using Particle Image Velocimetry

et al. 2011

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Despite rapid advancements in the patient-specific hemodynamic analysis of systemic arterial anatomies, limited attention has been given to the characterization of major venous flow components, such as the hepatic venous confluence. A detailed investigation of hepatic flow structures is essential to better understand the origin of characteristic abnormal venous flow patterns observed in patients with cardiovascular venous disease. The present study incorporates transparent rapid-prototype replicas of two pediatric hepatic venous confluence anatomies and two-component particle image velocimetry to investigate the primary flow structures influencing the inferior vena cava outflow. Novel jet flow regimes are reported at physiologically relevant mean venous conditions. The sensitivity of fluid unsteadiness and hydraulic resistance to multiple-inlet flow regimes is documented. Pressure drop measurements, jet flow characterization, and blood damage assessments are also performed. Results indicate that the orientation of the inlets significantly influences the major unsteady flow structures and power loss characteristics of this complex venous flow junction. Compared to out-of-plane arranged inlet vessel configuration, the internal flow field observed in planar inlet configurations was less sensitive to the venous inlet flow split. Under pathological flow conditions, the effective pressure drop increased as much as 77% compared to the healthy flow state. Experimental flow field results presented here can serve as a benchmark case for the surgical optimization of complex anatomical confluences including visceral hemodynamics as well as for the experimental validation of high-resolution computational fluid dynamics solvers applied to anatomical confluences with multiple inlets and outlets.

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Subdiaphragmatic venous hemodynamics in the Fontan circulation

Cited by 88 publications

References 37 publications

Transplantation and Mechanical Circulatory Support in Congenital Heart Disease

Transplantation and Mechanical Circulatory Support in Congenital Heart Disease

Older Age at Completion of Fontan Procedure Is Associated with Improved Percentage of Predicted Maximum Oxygen Uptake

Hemodynamics of the Hepatic Venous Three-Vessel Confluences Using Particle Image Velocimetry

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