Transition of ventricular function and energy efficiency after a primary or staged Fontan procedure

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• 作者：Manabu Watanabe (1)
  Mitsuru Aoki (2)
  Tadashi Fujiwara (2)
  
• 关键词：Total cavopulmonary connection ; Endsystolic elastance ; Effective arterial elastance ; Ventriculoarterial coupling
• 刊名：General Thoracic and Cardiovascular Surgery
• 出版年：2008
• 出版时间：October 2008
• 年：2008
• 卷：56
• 期：10
• 页码：498-504
• 全文大小：322KB
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• 作者单位：Manabu Watanabe (1)
  Mitsuru Aoki (2)
  Tadashi Fujiwara (2)
  
  1. Unit of Cardiovascular Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, 1-1 Kanayama, Teine-ku, Sapporo, Hokkaido, 006-0041, Japan
  2. Unit of Cardiovascular Surgery, Chiba Children鈥檚 Hospital, Chiba, Japan
  

文摘

Purpose The transitional changes of the ventricular function at different time points after total cavopulmonary connection (TCPC) were examined. Methods A total of 29 patients were divided into a primary TCPC group and a staged TCPC group. In both groups, phase I was defined as within 2 months after TCPC and phase II as beyond at least a year after TCPC. Changes in ventricular end-diastolic volume (EDV), ventricular end-systolic elastance (Ees), effective arterial elastance (Ea), and ventriculoarterial coupling (Ea/Ees) were evaluated. Results The results for the primary TCPC group are as follows. Phase I: The EDV decreased (P < 0.05). The Ees and Ea both increased (P < 0.05). Ea/Ees showed a tendency to increase (P = 0.08). Phase II: The EDV decreased (P < 0.05). The Ees increased significantly, and Ea showed no significant change. Ees/Ea showed a tendency to decrease (P = 0.07). The results for the staged TCPC group were as follows. Phase I: The EDV decreased significantly after bidirectional cavopulmonary shunt (BCPS). The Ees showed no significant change after BCPS and TCPC. Although Ea increased after BCPS (P < 0.05), it showed no significant change after TCPC. Ea/Ees showed no significant change. Phase II: The Ees increased (P < 0.05) without significant changes of EDV and Ea. As a result, Ea/Ees showed a tendency to decrease. Conclusion This study suggested improved ventricular function in both groups. These results suggest hemodynamic adaptation to the Fontan circulation. The deleterious effects on ventricular function caused by the Fontan procedure disappeared within a couple of years. This acute effect can be ameliorated by the staged approach to the Fontan circulation.