Ventricular‐Arterial Function and Coupling in the Adult Fontan Circulation

نویسندگان

  • Hirofumi Saiki
  • Benjamin W. Eidem
  • Tomohito Ohtani
  • Martha A. Grogan
  • Margaret M. Redfield
چکیده

BACKGROUND In adult Fontan patients, ventricular or arterial dysfunction may impact homeostasis of the Fontan circulation and predispose to heart failure. We sought to characterize ventricular-arterial (VA) properties in adult Fontan patients. METHODS AND RESULTS Adult Fontan patients (n=170), including those with right (SRV, n=57) and left (SLV, n=113) dominant ventricular morphology, were compared to age, sex, and body size matched controls (n=170). Arterial function, load-insensitive measures of contractility, VA coupling, diastolic function, and ventricular efficiency were assessed. Compared to controls, Fontan patients had similar arterial (Ea), but lower end-systolic ventricular (Ees), elastance, preload recruitable stroke work and peak power index, impaired VA coupling, eccentric remodeling, reduced ventricular efficiency and increased diastolic stiffness (P<0.05 for all). Ventricular efficiency declined steeply with higher heart rate in Fontan, but not control, patients. Among Fontan patients (n=123) and controls (n=162) with preserved cardiac index (CI; ≥2.5 L/min per m2), Fontan patients had worse contractility than controls, but CI was preserved owing to relative tachycardia, lower afterload, and eccentric remodeling. However, 25% of Fontan patients had reduced CI and were distinguished from those with preserved CI by less-eccentric remodeling and worse diastolic function, rather than more-impaired contractility. CONCLUSIONS Adult Fontan patients have contractile and diastolic dysfunction with normal afterload, impaired VA coupling, and reduced ventricular efficiency with heightened sensitivity to heart rate. Maintenance of CI is dependent on lower afterload, eccentric remodeling, and relative preservation of diastolic function. These data contribute to our understanding of circulatory physiology in adult Fontan patients.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Respiratory exacerbation in a young adult with cystic fibrosis and tricuspid atresia

Tricuspid atresia (TAt) is a complex congenital heart defect (CHD) characterized by the absence of the tricuspid valve and right ventricular hypoplasia requiring surgery in childhood, the Fontan procedure. We present a case of a 21-year-old male with TAt and cystic fibrosis (CF), who underwent a Fontan procedure in childhood, presenting to an adult CF clinic with severe deterioration in his res...

متن کامل

The Fontan circulation.

Correspondence to: Professor Marc Gewillig, Pediatric Cardiology, Gasthuisberg University Hospital, B 3000 Leuven, Belgium; marc.gewillig@ uzleuven.be _________________________ A normal mammal cardiovascular system consists postnatally of a double—pulmonary and systemic—circuit, connected in series, powered by a double pump—the ‘‘right’’ and ‘‘left’’ heart. Many complex cardiac malformations ar...

متن کامل

Long-term results after the Fontan operation for tricuspid atresia.

Between 1968 and 1977, 32 patients who underwent the Fontan operation for tricuspid atresia at Bordeaux, France, or Leiden, The Netherlands, survived at least 1 year after surgery. These patients were evaluated clinically 7 to 16 years (mean 8.9 years) after surgery by review of clinical records, questionnaire, or direct examination. There were five deaths: one during arrhythmia, the second sud...

متن کامل

Management of the failing Fontan circulation

The ‘Fontan circulation’ has evolved to include a variety of surgical procedures designed to overcome the absence of two distinct ventricular chambers. w1ew3 Inherent to this circulation is chronic elevation of right atrial and vena caval pressure, and absence of a dedicated power source to serve the pulmonary circulation, making low pulmonary vascular resistance and optimal systemic ventricula...

متن کامل

Cardiac rest and reserve function in patients with Fontan circulation.

OBJECTIVES In the present study, we systematically tested cardiac rest and reserve function in patients with Fontan physiology to check for inherent limitations of this circulation. BACKGROUND Details of the mechanisms of cardiac performance that could account for adverse outcome after Fontan surgery are not well understood. METHODS The subjects were 17 Fontan patients with good functional ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:

دوره 5  شماره 

صفحات  -

تاریخ انتشار 2016