| Pulmonary vascular resistance, collateral flow, and ventricular function in patients with a Fontan circulation at rest and during dobutamine stress. | |
| | |
MedLine Citation:
|
PMID: 20631032 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: The role, interplay, and relative importance of the multifactorial hemodynamic and myocardial mechanisms causing dysfunction of the Fontan circulation remain incompletely understood. METHODS AND RESULTS: Using an MRI catheterization technique, we performed a differential analysis of pulmonary vascular resistance and aortopulmonary collateral blood flow in conjunction with global ventricular pump function, myocontractility (end-systolic pressure-volume relation), and diastolic compliance (end-diastolic pressure-volume relation) in 10 patients with a Fontan circulation at rest and during dobutamine stress. Pulmonary and ventricular pressures were measured invasively and synchronized with velocity-encoded MRI-derived pulmonary and aortic blood flows and cine MRI-derived ventricular volumes. Pulmonary vascular resistance and end-systolic and end-diastolic pressure-volume relations were then determined. Aortopulmonary collateral flow was calculated as the difference between aortic and pulmonary flow. Compared to rest, dobutamine caused a small increase in mean pulmonary pressures (P<0.05). Collateral flow was significantly augmented (P<0.001) and contributed importantly to an increase in pulmonary flow (P<0.01). Pulmonary vascular resistance decreased significantly (P<0.01). Dobutamine did not increase stroke volumes significantly despite slightly enhanced contractility (end-systolic pressure-volume relation). Active early relaxation (τ) was inconspicuous, but the end-diastolic pressure-volume relation shifted upward, indicating reduced compliance. CONCLUSIONS: In patients with a Fontan circulation, aortopulmonary collateral flow contributes substantially to enhanced pulmonary flow during stress. Our data indicate that pulmonary vascular response to augmented cardiac output was adequate, but decreased diastolic compliance was identified as an important component of ventricular dysfunction. |
| | |
Authors:
|
Boris Schmitt; Paul Steendijk; Stanislav Ovroutski; Karsten Lunze; Pedram Rahmanzadeh; Nizar Maarouf; Peter Ewert; Felix Berger; Titus Kuehne |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-07-14 |
Journal Detail:
|
Title: Circulation. Cardiovascular imaging Volume: 3 ISSN: 1942-0080 ISO Abbreviation: Circ Cardiovasc Imaging Publication Date: 2010 Sep |
Date Detail:
|
Created Date: 2010-09-15 Completed Date: 2010-10-04 Revised Date: 2011-09-06 |
Medline Journal Info:
|
Nlm Unique ID: 101479935 Medline TA: Circ Cardiovasc Imaging Country: United States |
Other Details:
|
Languages: eng Pagination: 623-31 Citation Subset: IM |
Affiliation:
|
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin and The Charité, Medical University Berlin, Berlin, Germany, |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Collateral Circulation* Compliance Dobutamine / diagnostic use* Echocardiography, Doppler Exercise Tolerance Fontan Procedure / adverse effects* Humans Magnetic Resonance Imaging, Cine* Myocardial Contraction Predictive Value of Tests Pulmonary Circulation* Treatment Outcome Vascular Resistance* Ventricular Dysfunction, Left / diagnosis, etiology*, physiopathology Ventricular Function* Ventricular Pressure Young Adult |
| Chemical | |
Reg. No./Substance:
|
34368-04-2/Dobutamine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Correlation between the BRAF V600E Mutation and Tumor Invasiveness in Papillary Thyroid Carcinomas S...
Next Document: The timing and impact of follow-up studies after normal stress single-photon emission computed tomog...