Basal Pulmonary Vascular Resistance and Nitric Oxide Responsiveness Late After Fontan-Type Operation
| Autor: | A.N. Redington, Shay Cullen, M R de Leval, John E. Deanfield, J. Li, Sachin Khambadkone |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Heart Defects
Congenital Male Cardiac Catheterization Pulmonary Circulation Adolescent Endothelium medicine.medical_treatment Pulsatile flow Hemodynamics Fontan Procedure Nitric Oxide Fick principle Time Fontan procedure Oxygen Consumption Physiology (medical) Administration Inhalation Humans Medicine Child Lung business.industry Age Factors Angiography medicine.anatomical_structure Pulsatile Flow Anesthesia Heart catheterization Vascular resistance Female Vascular Resistance Endothelium Vascular Cardiology and Cardiovascular Medicine business Blood Flow Velocity |
| Zdroj: | Circulation. 107:3204-3208 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/01.cir.0000074210.49434.40 |
| Popis: | Background— The pulsatile nature of pulmonary blood flow is important for shear stress–mediated release of endothelium-derived nitric oxide (NO) and lowering pulmonary vascular resistance (PVR) by passive recruitment of capillaries. Normal pulsatile flow is lost or markedly attenuated after Fontan-type operations, but to date, there are no data on basal pulmonary vascular resistance and its responsiveness to exogenous NO at late follow-up in these patients. Methods and Results— We measured indexed PVR (PVRI) using Fick principle to calculate pulmonary blood flow, with respiratory mass spectrometry to measure oxygen consumption, in 15 patients (median age, 12 years; range, 7 to 17 years; 12 male, 3 female) at a median of 9 years after a Fontan-type operation (6 atriopulmonary connections, 7 lateral tunnels, 2 extracardiac conduits). The basal PVRI was 2.11±0.79 Wood unit (WU) times m 2 (mean±SD) and showed a significant reduction to 1.61±0.48 ( P =0.016) after 20 ppm of NO for 10 minutes. The patients with nonpulsatile group in the pulmonary circulation dropped the PVRI from 2.18±0.34 to 1.82±0.55 ( P Conclusions— PVR falls with exogenous NO late after Fontan-type operation. These data suggest pulmonary endothelial dysfunction, related in some part to lack of pulsatility in the pulmonary circulation because of altered flow characteristics. Therapeutic strategies to enhance pulmonary endothelial NO release may have a role in these patients. |
| Databáze: | OpenAIRE |
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