Impact of Atrial Fibrillation on Fontan Circulation: Fontan Computational Model
| Autor: | Tetsuya Ueda, Takashi Fujiwara, Masashi Kabasawa, Koichi Sughimoto, Hao Liu |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
Heart Defects
Congenital Pulmonary and Respiratory Medicine congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Cardiac output Hemodynamics Fontan Procedure Dobutamine Internal medicine Atrial Fibrillation Heart rate Humans Medicine Computer Simulation Sinus rhythm Heart Atria cardiovascular diseases business.industry Atrial fibrillation medicine.disease surgical procedures operative medicine.anatomical_structure Ventricle Heart failure cardiovascular system Cardiology Surgery Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | The Annals of Thoracic Surgery. 114:1460-1467 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2021.08.061 |
| Popis: | Background Patients with Fontan circulation may develop heart failure resulting in atrial fibrillation during the late phase. Inotropic effects to ameliorate hemodynamics on the Fontan circulation are not well understood, especially when in atrial fibrillation. This study was performed to determine whether dobutamine therapy in patients with Fontan circulation has limited effects on improving hemodynamics. Methods Lumped computational models (sinus and atrial fibrillation) were employed including biventricular, atriopulmonary connection (APC), and extracardiac total cavopulmonary connection (TCPC) Fontan models. The condition of atrial fibrillation including lack of atrial beat, irregular ventricular contraction, and time-varying elastance for the ventricle was introduced. A different dose of dobutamine was given by varying the elastance of the ventricle, heart rate, and peripheral resistance. Results In all models, the cardiac output decreased by 22.5% to 25.8% in atrial fibrillation. At 10 μg/kg/min of dobutamine in sinus rhythm, the cardiac output increased by 32.3% in the biventricular model but by only 9.2% (p Conclusions In the Fontan circulation, atrial fibrillation itself reduced the cardiac output by approximately 25%, and dobutamine had a limited effect on increasing the cardiac output, especially when in atrial fibrillation. Maintaining sinus rhythm in patients with Fontan circulation is very important. |
| Databáze: | OpenAIRE |
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