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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
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Pulsed Doppler echocardiographic assessment of patterns of venous flow after the modified Fontan operation: potential

R Kaulitz1, I Luhmer, H C Kallfelz

  • 1Department of Paediatric Cardiology, Children's Hospital, Medical School Hannover, Germany.

Cardiology in the Young
|July 29, 1998
PubMed

Insights

Total cavopulmonary anastomosis (TCPC) in Fontan operations shows reduced venous flow and increased respiratory dependence compared to atriopulmonary connections. This may impact hepatic function and lead to complications like hypoproteinemia.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Hepatology

Background:

  • The Fontan operation is a palliative procedure for single-ventricle congenital heart defects.
  • Different surgical techniques, such as atriopulmonary connection (APC) and total cavopulmonary anastomosis (TCPC), have evolved.
  • Understanding the hemodynamic impact of these modifications on systemic venous and hepatic circulation is crucial for patient outcomes.

Purpose of the Study:

  • To compare the effects of APC versus TCPC on systemic venous blood flow and hepatic circulation.
  • To evaluate Doppler echocardiographic parameters and laboratory findings in patients with different Fontan modifications.

Main Methods:

  • Compared 11 patients with APC and 35 with TCPC using Doppler echocardiography.
  • Assessed caval venous, hepatic venous, and portal venous flow, calculating pulsatility and respiratory variation.
  • Included cardiac catheterization and laboratory investigations for organ function.

Main Results:

  • TCPC patients exhibited significantly lower flow velocities, less pulsatility, and lower systolic/diastolic velocity ratios in systemic venous flow compared to APC.
  • Hepatic venous flow peak velocities were significantly lower in TCPC patients, with 22 showing respiration-dependent flow.
  • Portal venous flow velocity was lower in TCPC patients; hypoproteinemia and protein C deficiency were more prevalent in this group.

Conclusions:

  • Total cavopulmonary anastomosis results in altered systemic venous and hepatic blood flow dynamics compared to atriopulmonary connection.
  • The increased respiratory dependence of hepatic venous flow in TCPC patients may contribute to hepatic dysfunction and protein abnormalities postoperatively.

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