Measurement of the ductal L-R shunt during extracorporeal membrane oxygenation in the lamb
| Autor: | John Klaessens, Arno van Heijst, Ronald B. Tanke, Otto Daniëls, Cees Festen |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Cardiac output
medicine.medical_specialty medicine.medical_treatment Persistent Fetal Circulation Syndrome Extracorporeal Membrane Oxygenation medicine.artery Ascending aorta medicine Extracorporeal membrane oxygenation Animals Humans Cardiac Output Heart lung and circulation [UMCN 2.1] Ductus Arteriosus Patent Sheep business.industry Ultrasound Infant Newborn General Medicine medicine.disease Pulmonary hypertension Surgery Shunt (medical) Disease Models Animal surgical procedures operative Blood Circulation Pediatrics Perinatology and Child Health Pulmonary artery business |
| Zdroj: | Journal of Pediatric Surgery, 39, 1, pp. 43-7 Journal of Pediatric Surgery, 39, 43-7 |
| ISSN: | 0022-3468 |
| DOI: | 10.1016/j.jpedsurg.2003.09.017 |
| Popis: | Contains fulltext : 57258.pdf (Publisher’s version ) (Closed access) OBJECTIVE: In neonates, initially a ductal shunt is often observed during veno-arterial extracorporeal membrane oxygenation (ECMO). Depending on the degree of pulmonary hypertension in these patients, the ductal shunt will be right to left (R-L), left to right (L-R), or bidirectional. A ductal L-R shunt will possibly lead to pulmonary hyperperfusion and interact with ECMO weaning. The aim of this study was to give more insight in this ductal L-R shunt during ECMO by quantification of this shunt in relation to cardiac output and ECMO flow. METHODS: In 7 lambs, closure of the duct was prevented by infiltration of the ductal wall with 10% formaline. This patent duct could be closed using a vesselloop around the duct. Ultrasound flowprobes were installed around the pulmonary artery, ascending aorta, and around the ECMO circulation tube. Right and left ventricular output and ECMO flow were measured. Ductus flow was defined as ductal left to right shunt (Qduct L-R) = flow in ascending aorta (Qao) - flow in central pulmonary artery (Qpa) and Qduct R-L = Qpa = Qao. RESULTS: In 6 of 7 lambs a ductal L-R shunt was observed with a mean shunt of 44% (range, 11 to 79) of left ventricular output (Qduct L-R/Qao). Comparison with ECMO flow (Qduct L-R/Qecmo) showed a mean shunt of 76% (range 15 to 230). When compared with the total systemic circulating volume (Qpa + flow in the ECMO circuit [Qecmo]), the mean ductal L-R shunt showed a percentage of 51% (range, 7% to 142%). CONCLUSIONS: During ECMO, mostly a ductal L-R shunt is observed in this lamb model. This ductal shunt is hemodynamically important. The percentages of this shunt in comparison with left ventricular output, and total circulating volume will support the idea that a ductal L-R shunt during ECMO could be another deteriorating factor in the often critical circulation of the neonate on veno-arterial ECMO. |
| Databáze: | OpenAIRE |
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