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Blood reservoir function in patients with Fontan circulation and asplenia syndrome

Published online by Cambridge University Press:  21 June 2019

Michitaka Fuse ,
Kenji Sugamoto ,
Seiko Kuwata ,
Rika Sekiya ,
Kohei Kawada ,
Miku Toki ,
Masahiro Kaneko ,
Yoichi Iwamoto ,
Hirotaka Ishido  and
Satoshi Masutani
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Michitaka Fuse
Affiliation:
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Kenji Sugamoto
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Seiko Kuwata
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Rika Sekiya
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Kohei Kawada
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Miku Toki
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Masahiro Kaneko
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Yoichi Iwamoto
Affiliation:
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Hirotaka Ishido
Affiliation:
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Satoshi Masutani
Affiliation:
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Manabu Kenmochi
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Hirofumi Saiki
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Hideaki Senzaki*
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
*
Author for correspondence: Prof. Hideaki Senzaki, MD, Department of Pediatrics, Pediatric Cardiology, Kitasato University School of Medicine, IPE Building 413, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan. Tel: +81-42-778-8192; Fax: +81-42-778-8441; Email: hsenzaki@med.kitasato-u.ac.jp
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Abstract

Splanchnic circulation constitutes a major portion of the vasculature capacitance and plays an important role in maintaining blood perfusion. Because patients with asplenia syndrome lack this vascular bed as a blood reservoir, they may have a unique blood volume and distribution, which may be related to their vulnerability to the haemodynamic changes often observed in clinical practice. During cardiac catheterisation, the mean circulatory filling pressure was calculated with the Valsalva manoeuvre in 19 patients with Fontan circulation, including 5 patients with asplenia syndrome. We also measured the cardiac output index and circulatory blood volume by using a dye dilution technique. The blood volume and the mean circulatory filling pressure and the venous capacitance in patients with asplenia syndrome were similar to those in the remaining patients with Fontan circulation (85 ± 14 versus 77 ± 18 ml/kg, p = 0.43, 31 ± 8 versus 27 ± 5 mmHg, p = 0.19, 2.8 ± 0.6 versus 2.9 ± 0.9 ml/kg/mmHg, p = 0.86). Unexpectedly, our data indicated that patients with asplenia syndrome, who lack splanchnic capacitance circulation, have blood volume and venous capacitance comparable to those in patients with splanchnic circulation. These data suggest that (1) there is a blood reservoir other than the spleen even in patients with asplenia; (2) considering the large blood pool of the spleen, the presence of a symmetrical liver may represent the possible organ functioning as a blood reservoir in asplenia syndrome; and (3) if this is indeed the case, there may be a higher risk of hepatic congestion in patients with Fontan circulation with asplenia syndrome than in those without.

Keywords

Vascular capacitanceaspleniamean circulatory filling pressure
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 8 , August 2019 , pp. 1016 - 1019
Copyright
© Cambridge University Press 2019 

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Footnotes

*

These authors contributed equally to this work.

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