Circulation, Vol 86, 196-202, Copyright © 1992 by American Heart Association
ZM Hijazi, JT Fahey, CS Kleinman, GS Kopf and WE Hellenbrand
BACKGROUND. Acute changes in hemodynamics and oxygen delivery accompanying
temporary occlusion of atrial defects in 14 patients after a fenestrated
Fontan procedure were evaluated at a median interval of 32 days after
surgery to identify candidates for permanent transcatheter closure of their
defects. METHODS AND RESULTS. Patients ranged in age from 9 months to 33
years and in weight from 7.9 to 69 kg. Right atrial (RA), left atrial (LA),
and aortic pressures, mixed venous (SmvO2) and aortic (SaO2) oxygen
saturation, and whole-body oxygen consumption (VO2) were measured, and
systemic blood flow (Qs), systemic oxygen transport (SOT), and oxygen
extraction were calculated before and after occlusion. SmvO2, VO2, and RA
pressures did not change, but SaO2 increased from 84 +/- 6% to 95 +/- 3% (p
less than 0.05), and LA pressures fell from 5.1 +/- 3.6 to 3.7 +/- 2.2 mm
Hg (p less than 0.05). Qs fell from 2.4 +/- 0.7 to 1.8 +/- 0.41.min-1.m-2
(p less than 0.05), SOT fell from 425 +/- 154 to 366 +/- 112 ml.O2.min-1.m-
2 (p less than 0.05), and oxygen extraction increased from 0.40 +/- 0.12 to
0.46 +/- 0.13 (p less than 0.05). Only one patient did not undergo
definitive closure of his defect because of a marked decrease in Qs and SOT
with a significant rise in RA pressure. CONCLUSIONS. Although delayed
closure of an atrial defect in these patients improved morbidity and
mortality, the complete separation of the venous and systemic circulations
was accomplished at the expense of decreased Qs and oxygen delivery despite
the improved level of arterial oxygenation. The resting levels of oxygen
extraction are elevated and will be associated with decreased exercise
capability. The long-term benefits of closure of these fenestrations are
yet to be shown.
ARTICLES
Hemodynamic evaluation before and after closure of fenestrated Fontan. An acute study of changes in oxygen delivery
Department of Pediatrics, Yale University School of Medicine, New Haven, Conn. 06510.
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