Format

Send to

Choose Destination
Sci Rep. 2019 Feb 14;9(1):2034. doi: 10.1038/s41598-019-38848-5.

Heart beat but not respiration is the main driving force of the systemic venous return in the Fontan circulation.

Author information

1
Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, Kiel, Germany.
2
Asklepios, Department of General Pediatrics and Adolescent Medicine, St. Augustin, Germany.
3
Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
4
The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, CA, 92697, Irvine, USA.
5
Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, Kiel, Germany. c.rickers@uke.de.
6
University Heart Center, Adult with Congenital Heart Disease Unit, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. c.rickers@uke.de.

Abstract

The Fontan procedure provides relief from cyanosis in patients with univentricular hearts. A major clinical unmet need is to understand whether the venous flow patterns of the Fontan circulation lead to the development of congestive hepatopathy and other life-threatening complications. Currently, there is no consensus on whether heart beat or respiration is the main driving force of venous return and which one affects the periodic flow changes for the most (i. e., pulsatility). The present study, for the first time, quantified respiratory and cardiac components of the venous flow in the inferior vena cava (IVC) of 14 Fontan patients and 11 normal controls using a novel approach ("physio-matrix"). We found that in contrast to the normal controls, respiration in Fontan patients had a significant effect on venous flow pulsatility, and the ratio of respiration-dependent to the cardiac-dependent pulsatility was positively associated with the retrograde flow. Nevertheless, the main driving force of net IVC flow was the heart beat and not respiration. The separate analysis of the effects of respiration and heart beat provides new insights into the abnormal venous return patterns that may be responsible for adverse effects on liver and bowel of the patients with Fontan circulation.

Supplemental Content

Full text links

Icon for Nature Publishing Group Icon for PubMed Central
Loading ...
Support Center