Ventricular mechanics in the bidirectional glenn procedure and total cavopulmonary connection

Tanoue, Yoshihisa; Sese, Akira; Imoto, Yutaka; Joh, Kunitaka

doi:10.1016/s0003-4975(03)00467-3

Cited by 40 publications

(30 citation statements)

References 23 publications

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“…Tanoue et al reported that volume-load reduction of the systemic ventricle resulted in an improvement in contractility after the Fontan operation [11]. Another possible factor is the adverse effect of cyanosis on ventricular function in the pre-Fontan condition.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcome of the Fontan operation in patients with impaired ventricular function☆

Kotani¹,

Kasahara²,

Fujii³

et al. 2009

European Journal of Cardio-Thoracic Surgery

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Section: Discussionmentioning

confidence: 99%

“…Tanoue et al reported the ventricular function to improve after BDG due to the unloading effect of the ventricle [11]. On the other hand, significant AVVR, which can negatively influence or impair the ventricular function, should be addressed during the staged Fontan procedure.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of the Fontan operation in patients with impaired ventricular function☆

Kotani¹,

Kasahara²,

Fujii³

et al. 2009

European Journal of Cardio-Thoracic Surgery

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“…Several studies have reported an increased SVR with abnormal ventriculoarterial coupling in Fontan patients and that the reduction in SVR during exercise is less than in the normal subject. 6,[36][37][38] However, afterload reduction using enalapril has failed to improve exercise hemodynamics and has even showed a tendency to worsen exercise performance in Fontan patients. 39 It is difficult to determine whether the abnormal vascular characteristics are a primary phenomenon associated with the Fontan circulation or that the increased peripheral tone is established as a means to maintaining blood pressure when cardiac output augmentation is reduced.…”

Section: Effect Of Sildenafil On Exercise Hemodynamicsmentioning

confidence: 99%

Sildenafil Improves Exercise Hemodynamics in Fontan Patients

Bruaene

Gerche

Claessen

et al. 2014

Circ: Cardiovascular Imaging

126

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Sildenafil targets the endothelial NO pathway by inhibiting phosphodiesterase-5, increasing cGMP, and inducing pulmonary vasodilation.7 Giardini et al 8 demonstrated an improvement in peak oxygen consumption and CI after a single oral Background-Patients with Fontan circulation have reduced exercise capacity. The absence of a presystemic pump may limit flow through the pulmonary circulation, restricting ventricular filling and cardiac output. We evaluated exercise hemodynamics and the effect of sildenafil on exercise hemodynamics in Fontan patients. Methods and Results-Ten Fontan patients (6 men, 20±4 years) underwent cardiac magnetic resonance imaging at rest and during supine bicycle exercise before and after sildenafil. Systemic ventricular volumes were obtained at rest and during low-(34±15 W), moderate-(69±29 W), and high-intensity (97±36 W) exercise using an ungated, free-breathing cardiac magnetic resonance sequence and analyzed correcting for cardiac phase and respiratory translation. Radial and pulmonary artery pressures and cGMP were measured. Before sildenafil, cardiac index increased throughout exercise (4.0±0.9, 5.9±1.1, 7.0±1.6, 7.4±1.7 L/(min·m 2 ); P<0.0001) with 106±49% increase in heart rate. Stroke volume index (P=0.015) and end-diastolic volume index (P=0.001) decreased during exercise. End-systolic volume index remained unchanged (P=0.8). Total pulmonary resistance index (P=0.005) increased, whereas systemic vascular resistance index decreased during exercise (P<0.0001). Sildenafil increased cardiac index (P<0.0001) and stroke volume index (P=0.003), especially at high-intensity exercise (interaction P=0.004 and P=0.003, respectively). Systemic vascular resistance index was reduced (P<0.0001-interaction P=0.1), whereas total pulmonary resistance index was reduced at rest and reduced further during exercise (P=0.008-interaction P=0.029). cGMP remained unchanged before sildenafil (P=0.9), whereas it increased significantly after sildenafil (P=0.019). Conclusions-In Fontan patients, sildenafil improved cardiac index during exercise with a decrease in total pulmonary resistance index and an increase in stroke volume index. This implies that pulmonary vasculature represents a physiological limitation, which can be attenuated by sildenafil, the clinical significance of which warrants further study. (Circ Cardiovasc Imaging. 2014;7:265-273.)

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“…1,2 Advantages of a BCPS include effective pulmonary blood flow without increased volume overload, low pulmonary arterial (PA) pressure, and less PA distortion. 1,3 However, the BCPS provides less pulmonary blood flow than completed Fontan or normal circulation, which may lead to limited PA growth before Fontan completion. There are some controversies regarding the usefulness of leaving additional pulmonary blood flow (APBF) at the time of BCPS.…”

Section: Introductionmentioning

confidence: 99%

Bidirectional Cavopulmonary Shunt with Additional Pulmonary Blood Flow

Suzuki¹,

Yamauchi²,

Daitoku³

et al. 2010

Asian Cardiovasc Thorac Ann

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There are some controversies regarding the usefulness of leaving additional pulmonary blood flow when establishing a bidirectional cavopulmonary shunt. From April 2002 to September 2008, 13 patients (mean age, 24 +/- 16 months) underwent a bidirectional cavopulmonary shunt procedure with fine adjustment of additional pulmonary blood flow, as an intermediate step before the Fontan operation. There were no hospital deaths. Modified Blalock-Taussig shunts were left during the bidirectional cavopulmonary shunt operation in 7 patients, and pulmonary bands were tightened in 4. The main pulmonary artery with a previous pulmonary band was left open in one case. Oxygen saturation increased from 74.5% +/- 7.4% to 84.6% +/- 1.9% after the operation, cardiothoracic ratio decreased from 55.9% +/- 6.1% to 53.2% +/- 3.4%, Left ventricular end-diastolic pressure decreased from 11.0 +/- 2.6 to 7.8 +/- 3.0 mm Hg, and mean pulmonary arterial pressure from 14.7 +/- 7.5 to 10.2 +/- 3.1 mm Hg. Pulmonary artery index did not change significantly. In our experience, additional pulmonary blood flow with adjustment in each patient at the time of shunt construction was an excellent temporary palliation prior to the Fontan operation.

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Ventricular mechanics in the bidirectional glenn procedure and total cavopulmonary connection

Cited by 40 publications

References 23 publications

Clinical outcome of the Fontan operation in patients with impaired ventricular function☆

Clinical outcome of the Fontan operation in patients with impaired ventricular function☆

Sildenafil Improves Exercise Hemodynamics in Fontan Patients

Bidirectional Cavopulmonary Shunt with Additional Pulmonary Blood Flow

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