Ventricular mechanics in the bidirectional glenn procedure and total cavopulmonary connection
| Autor: | Akira Sese, Yoshihisa Tanoue, Kunitaka Joh, Yutaka Imoto |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Heart Defects
Congenital Male Pulmonary and Respiratory Medicine Mean arterial pressure medicine.medical_specialty medicine.medical_treatment Hemodynamics Fontan Procedure Risk Assessment Sampling Studies Ventricular Function Left Bidirectional Glenn procedure Afterload Internal medicine Ventricular Pressure medicine Humans Prospective Studies cardiovascular diseases Derivation Cardiac Surgical Procedures Child Probability Cardiac catheterization Analysis of Variance business.industry Anastomosis Surgical Infant Stroke Volume Stroke volume Myocardial Contraction Treatment Outcome Child Preschool Anesthesia Ventricular Function Right cardiovascular system Cardiology Ventricular pressure Female Surgery Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 76:562-566 |
| ISSN: | 0003-4975 |
| Popis: | Background The time course of ventricular efficiency in Fontan candidates who underwent both the bidirectional Glenn procedure (BDG) and total cavopulmonary connection (TCPC) were analyzed in this study. We previously reported that volume-load reduction of BDG preceding TCPC allowed for any afterload mismatch to be corrected, thereby improving ventricular efficiency after staged TCPC. Methods We measured percent normal systemic ventricular end-diastolic volume (%N-EDV), contractility (end-systolic elastance [Ees]), afterload (effective arterial elastance [Ea]), and ventricular efficiency (ventriculoarterial coupling [Ea/Ees]) based on cardiac catheterization data before and after both BDG and staged TCPC in 30 patients. Ees and Ea were approximated as follows: Ees=mean arterial pressure/minimal ventricular volume, and Ea=maximal ventricular pressure/(maximal ventricular volume − minimal ventricular volume), and Ea/Ees was then calculated. Ventricular volume was divided by body surface area. Results The %N-EDV decreased both after BDG and after staged TCPC, thus resulting in an improvement of Ees. Although Ea increased both after BDG and after staged TCPC, Ea decreased during the interval between BDG and staged TCPC. These changes resulted in an improvement in Ea/Ees during the interval period and after staged TCPC, although Ea/Ees worsened after BDG. Conclusions Correction of afterload mismatch during the interval period between BDG and staged TCPC is considered to be one of the most important factors for obtaining excellent clinical results when selecting a staged strategy to treat high-risk Fontan candidates. |
| Databáze: | OpenAIRE |
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