Document Detail

Ventricular afterload and ventricular work in fontan circulation: comparison with normal two-ventricle circulation and single-ventricle circulation with blalock-taussig shunts.
MedLine Citation:
PMID:  12070118     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Recent studies have indicated that there are inherent limitations associated with Fontan physiology. However, there have been no quantitative analyses of the effects of right heart bypass on ventricular afterload, hydraulic power, and resultant overall hemodynamics. Methods and Results- During routine cardiac catheterization, aortic impedance and ventricular hydraulic power were determined, both at rest and under increased ventricular work induced by dobutamine, in 17 patients with Fontan circulation, 15 patients with a single ventricle whose pulmonary circulation was maintained only by Blalock-Taussig shunts, and 13 patients who had normal 2-ventricle circulation. Both vascular resistance (nonpulsatile load on the ventricle) and pulsatile components of ventricular afterload (represented by low-frequency impedance) were significantly higher in the Fontan group than in the other groups (P<0.01), and this was associated with decreased cardiac output in the Fontan patients. In addition, hydraulic power cost per unit forward flow was 40% lower in the 2-ventricle circulation than in the single-ventricle circulation, suggesting lower ventricular efficiency in single-ventricle circulation attributable to the lack of a pulmonary ventricle. Furthermore, in the Fontan group, beta-adrenergic reserve was markedly decreased because of a limited preload reserve.
CONCLUSIONS: Fontan physiology is associated with disadvantageous ventricular power and afterload profiles and has limited ventricular reserve capacity. Thus, to improve the long-term prognosis of patients after Fontan surgery, future research should be conducted into medical interventions that can overcome these limitations inherent in Fontan circulation.
Hideaki Senzaki; Satoshi Masutani; Jun Kobayashi; Toshiki Kobayashi; Nozomu Sasaki; Haruhiko Asano; Shunei Kyo; Yuji Yokote; Akira Ishizawa
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Retracted Publication    
Journal Detail:
Title:  Circulation     Volume:  105     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-06-18     Completed Date:  2002-06-28     Revised Date:  2013-05-20    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2885-92     Citation Subset:  AIM; IM    
Department of Pediatric Cardiology, Saitama Medical School Hospital, Saitama, National Children's Hospital, Tokyo, Japan.
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MeSH Terms
Adrenergic beta-Agonists / pharmacology
Anastomosis, Surgical
Cardiography, Impedance
Child, Preschool
Coronary Circulation*
Dobutamine / pharmacology
Fontan Procedure*
Heart Defects, Congenital / physiopathology,  surgery*
Heart Ventricles / physiopathology*
Hemodynamics / drug effects
Pulmonary Circulation
Pulsatile Flow
Vascular Resistance
Reg. No./Substance:
0/Adrenergic beta-Agonists; 34368-04-2/Dobutamine
Retraction In:
Circulation. 2012 Jun 12;125(23):e1020   [PMID:  22689940 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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