Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-06-09T04:46:01.091Z Has data issue: false hasContentIssue false
  • English
  • Français

Pulsed Doppler echocardiographic assessment of patterns of venous flow after the modified Fontan operation: potential clinical implications

Published online by Cambridge University Press:  19 August 2008

Renate Kaulitz ,
Ingrid Luhmer  and
Hans Carlo Kallfelz
Renate Kaulitz*
Affiliation:
Department of Paediatric Cardiology, Children's Hospital, Medical School Hannover, Germany
Ingrid Luhmer
Affiliation:
Department of Paediatric Cardiology, Children's Hospital, Medical School Hannover, Germany
Hans Carlo Kallfelz
Affiliation:
Department of Paediatric Cardiology, Children's Hospital, Medical School Hannover, Germany
*
Renate Kaulitz, MD, Dept. Paediatric Cardiology, Children's Hospital Hannover, 30623 HannoverGermany. Tel: 49 511 532 3220, Fax: 49 511 532 9038
Get access Rights & Permissions [Opens in a new window]

Abstract

To assess the effect of a modified Fontan operation on systemic venous blood flow and the hepatic circulation, we compared 11 patients having an atriopulmonary connection and 35 with total cavopulmonary anastomosis. The Doppler echocardiographic study of the caval venous, hepatic venous and portal venous flow was performed so as to calculate the pulsatility ratio and the variation of flow with respiration. All patients had undergone cardiac catheterization. In addition, we included specific laboratory investigations to assess function of various organs.

Significantly lower maximum velocities of flow at inspiration (0.31±0.12 rn/sec vs 0.45±0.14 m/sec) and expiration (0.23±0.09 rn/sec vs 0.32±0.11 m/sec), less pulsatility (0.43 vs 0.16) and a lower ratio of systolic to diastolic velocity (1.22 vs 1.85) were found in the patients having a cavopulmonary as compared to an atriopulmonary anastomosis. Peak velocities of hepatic venous flow during inspiration and expiration were significantly lower in those with a cavopulmonary anastornosis (p=O.OOl and p<O.OOl, respectively). In these patients, forward flow was extremely dependent on respiration, with decrease or cessation of antegrade flow during expiration in 22 patients. The velocity of portal venous flow was also significantly lower in these patients, although the pulsatility ratio did not differ significantly between the groups (0.5 ± 0.21 and 0.57 ± 0.23, respectively). The ratio of inspiratory and expiratory velocities showed no significant difference between the groups, nor was there any correlation between the pulsatility ratio of the venous vessels or the ratio of peak flow velocities during expiration and the mean systemic venous/right atrial pressure on postoperative cardiac catheterization. Hypoproteinemia was found in 8 patients after total cavopulmonary anastomosis; 9 of 10 patients with protein C deficiency belonged to this group.

The dependence of hepatic venous flow on respiration in the presence of a chronically elevated systemic venous pressure in patients after the total cavopulmonary anastornosis may influence hepatic function in the postoperative period.

Keywords

Modified Fontan operationtotal cavopulmonary anastomosisDoppler echocardiographyportal venous flowhepatic venous flow
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 1 , January 1998 , pp. 54 - 62
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Kreutzer, G, Galindez, E, Bono, H, de Palma, C, Laura, JP. An operation for the correction of tricuspid atresia. J Thorac Cardiovasc Surg 1973;66:613–621.CrossRefGoogle ScholarPubMed
2. Puga, FJ, Chiavarelli, M, Hagler, DJ. Modification of the Fontan operation applicable to patients with left atrioventricular valve atresia or single atrioventricular valve. Circulation 1987;76(Pt2):III53–60.Google ScholarPubMed
3. DeLeval, MR, Kilner, Ph, Gewillig, M, Bull, C. Total cavopulmonary connection: A logical alternative to atriopulmonary connection for complex Fontan operations. J Thorac Cardiovasc Surg 1988;96:682–695.CrossRefGoogle Scholar
4. Castaneda, AR. From Glenn to Fontan: a continuing evolution. Circulation 1992;96:682–695.Google Scholar
5. Kawashima, Y, Kitamura, S, Matsuda, H, Shimazaki, Y, Nakano, S, Hirose, H. Total cavopulmonary shunt operation in complex cardiac anomalies. J Thorac Cardiovasc Surg 1984;87:74–81.CrossRefGoogle ScholarPubMed
6. Jonas, RA, Castaneda, AR. Modified Fontan procedure: atrial baffle and systemic venous to pulmonary artery anastomotic techniques. J Cardiac Surg 1988; 3:91–96.CrossRefGoogle ScholarPubMed
7. Jonas, RA. The importance of pulsatile flow when systemic venous return is connected directly to the pulmonary arteries. J Thorac Cardiovasc Surg 1993;105:173–188.CrossRefGoogle Scholar
8. Penny, DJ, Redington, AN. Doppler echocardiographic evaluation of pulmonary blood flow after the Fontan operation the role of the lungs. Br Heart J 1991;66:372–374.CrossRefGoogle ScholarPubMed
9. Qureshi, SA, Richheimer, R, McKay, R, Arnold, R. Doppler echocardiographic evaluation of pulmonary artery blood flow after modified Fontan operation: importance of atrial contraction. Br Heart J 1990;64:272–276.CrossRefGoogle ScholarPubMed
10. Redington, AN, Penny, D, Shinebourne, EA. Pulmonary blood flow after total cavopulmonary shunt. Br Heart J 1991;65:213–217.CrossRefGoogle ScholarPubMed
11. Arisawa, J, Morimoto, S, Ikezoe, J, Naitoh, H, Yamagami, H, Kozuka, T, Sano, T, Shimazaki, Y, Matsuda, H. Pulsed Doppler echocardiographic assessment of portal venous flow pattern in patients after the Fontan operation. Br Heart J 1993;69:41–46.CrossRefGoogle ScholarPubMed
12. Meyer, RJ, Goldberg, SJ, Donnerstein, R. Superior vena cava and hepatic vein flow velocity patterns in normal children. Am J Cardiol 1993;72:238–240.CrossRefGoogle ScholarPubMed
13. Snider, RA, Serwer, GA. Echocardiography in Pediatric Heart Disease. Year Book Medical Publisher, Inc., Littleton, Mass., 1990, pp 55–56.Google Scholar
14. Bender, AM, Baron, JA, Goldberg, SJ, Bouher, NJ. Hepatic vein velocities in children with right ventricular hypertension. Am J Cardiol 1995;75:971–973.CrossRefGoogle ScholarPubMed
15. Appleton, CP, Hatle, LK, Popp, RL. Superior vena cava and hepatic vein Doppler in healthy adults. J Am Coil Cardiol 1987;10:1032–1039.CrossRefGoogle ScholarPubMed
16. Sakai, K, Nakamura, K, Satomi, G, Kondo, M, Hirosawa, K. Evaluation of tricuspid regurgitation by blood flow pattern in the hepatic vein using pulsed Doppler technique. Am Heart J 1984;108:516–522.CrossRefGoogle ScholarPubMed
17. Nishimura, RA, Abel, MD, Hatle, LK, Tajik, AJ. Assessment of diastolic function of the heart: Background and current applications of Doppler echocardiography. Mayo Clin Proc 1989;64:181–204.CrossRefGoogle ScholarPubMed
18. Abu-Youssef, MM, Milam, SG, Earner RM. Pulsatile portal vein flow: A sign of tricuspid regurgitation on duplex Doppler sonography. AJR 1990;155:785–788.CrossRefGoogle Scholar
19. Hosoki, T, Arisawa, J, Marukawa, T, Togunaga, K, Kuroda, C, Kozuka, T, Nakano S. Portal blood flow in congestive heart failure: pulsed duplex sonographic findings. Radiology 1990; 174:733–736.CrossRefGoogle ScholarPubMed
20. Di Sessa, TG, Child, JS, Perloff, JK. Systemic venous and pulmonary arterial flow patterns after Fontan's procedure for tricuspid atresia or single ventricle. Circulation 1984;70:898–902.CrossRefGoogle ScholarPubMed
21. Hess, J, Kruizinga, K, Bijieveld, CMA, Hardjowijono, R, Eygelaar, A. Protein-losing enteropathy after Fontan operation. J Thorac Cardiovasc Surg 1984;88:606–609.CrossRefGoogle ScholarPubMed
22. Driscoll, DJ, Offord, KP, Feldt, RH, Schaff, HV, Puga, J, Danielson, GK. Five- to fifteen-year follow-up after Fontan operation. Circulation 1992;85:469–496.CrossRefGoogle ScholarPubMed
23. Cromme-Dijkhuis, AH, Hess, J, Hählen, K, Henkens, CMA, Bink-Boelkens, MT, Eygelaar, AA, Bos, E. Specific sequelae after Fontan operation at mid- and long-term follow-up. J Thorac Cardiovasc Surg 1993;106:1126–1132.CrossRefGoogle ScholarPubMed