Where Is the “Optimal” Fontan Hemodynamics?
نویسنده
چکیده
Fontan circulation is generally characterized by high central venous pressure, low cardiac output, and slightly low arterial oxygen saturation, and it is quite different from normal biventricular physiology. Therefore, when a patient with congenital heart disease is selected as a candidate for this type of circulation, the ultimate goals of therapy consist of 2 components. One is a smooth adjustment to the new circulation, and the other is long-term circulatory stabilization after adjustment. When either of these goals is not achieved, the patient is categorized as having "failed" Fontan circulation, and the prognosis is dismal. For the first goal of smooth adjustment, a lot of effort has been made to establish criteria for patient selection and intensive management immediately after the Fontan operation. For the second goal of long-term circulatory stabilization, there is limited evidence of successful strategies for long-term hemodynamic stabilization. Furthermore, there have been no data on optimal hemodynamics in Fontan circulation that could be used as a reference for patient management. Although small clinical trials and case reports are available, the results cannot be generalized to the majority of Fontan survivors. We recently reported the clinical and hemodynamic characteristics of early and late failing Fontan survivors and their association with all-cause mortality. This knowledge could provide insight into the complex Fontan pathophysiology and might help establish a management strategy for long-term hemodynamic stabilization.
منابع مشابه
Optimization of inflow waveform phase-difference for minimized total cavopulmonary power loss.
The Fontan operation is a palliative surgical procedure performed on children, born with congenital heart defects that have yielded only a single functioning ventricle. The total cavo-pulmonary connection (TCPC) is a common variant of the Fontan procedure, where the superior vena cava (SVC) and inferior vena cava (IVC) are routed directly into the pulmonary arteries (PA). Due to the limited pum...
متن کاملContinuous intraoperative TEE monitoring for a child with Fontan pathway undergoing post spinal fusion.
The following case report describes a very challenging surgical case where the use of intraoperative, continuous TEE monitoring in the prone position was crucial for the anesthetic management (diagnosis and treatment) of a patient with single ventricle physiology. The use of TEE monitoring enabled the anesthesia team to continuously assess hemodynamic stability and respond immediately to hypote...
متن کاملAcute hemodynamic effects of pacing in patients with Fontan physiology: a prospective study.
OBJECTIVES The purpose of this research was to assess the hemodynamic response to atrial, ventricular, and dual-chamber pacing in patients with Fontan physiology. BACKGROUND Bradycardia, due to sinus node dysfunction or atrioventricular (AV) block, with need for pacing, is common after the Fontan operation. The optimal pacing mode for Fontan patients is unknown, but is critical, as hemodynami...
متن کاملSildenafil Improves Exercise Hemodynamics in Fontan Patients Van De Bruaene et al: Sildenafil and Exercise Hemodynamics in Fontan Patients
متن کامل
In vivo quantification of blood mixing in single ventricle patients with Fontan circulation using 4D flow MRI
Background Single ventricle physiology (SVP) is one of the most severe forms of complex congenital heart disease (CHD). Patients undergo multiple surgical interventions including the Fontan procedure (caval venous return is routed directly to the pulmonary arteries). Despite the apparent success of the procedure, it is unclear why some patients develop ‘failing Fontan physiology’ while others r...
متن کامل