Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural effusions after the fontan operation

Cara A. Garofalo, Santos E. Cabreriza, T. Alexander Quinn, Alan D. Weinberg, Beth F. Printz, Daphne T. Hsu, Jan M. Quaegebeur, Ralph S. Mosca, Henry M. Spotnitz

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

BACKGROUND - We validated the clinical relevance of ventricular stiffness by examining surgical morbidity in children with univentricular hearts undergoing Fontan operation. We hypothesized that ventricular stiffness affects Fontan morbidity, particularly duration of pleural effusions. METHODS AND RESULTS - Sixteen children with right ventricular (RV) (n =11) or left ventricular (LV) (n =5) dominance were studied intraoperatively at a median age of 3.3 years (1.8 to 5.1). Transesophageal long-axis echocardiograms and ventricular pressure by micromanometer provided end-diastolic pressure (P) area (A) relations during initiation and conclusion of cardiopulmonary bypass. Curve fitting to the equation P=αe defined the ventricular stiffness constant, β. Changes in β and clinical correlations were examined. Ventricular stiffness increased after bypass in patients with complete pre-bypass and post-bypass data (n =11, P=0.023, mixed models methodology). Pre-bypass β correlated well with duration of chest tube (CT) drainage (r=0.90, n =16), net perioperative fluid balance (r=0.71, n=14), and length of stay (LOS) (r=0.81, n =16). CT duration and LOS also correlated significantly with post-bypass β (r=0.77 for both, n=11), but insignificantly with preoperative catheterization pressures. CONCLUSIONS - Intraoperative β predicts duration of CT drainage, net perioperative fluid balance, and LOS after the Fontan operation. These observations could improve risk stratification and clinical management of children at high-risk undergoing the Fontan operation.

Original languageEnglish (US)
JournalCirculation
Volume114
Issue numberSUPPL. 1
DOIs
StatePublished - Jul 2006
Externally publishedYes

Fingerprint

Fontan Procedure
Chest Tubes
Pleural Effusion
Length of Stay
Water-Electrolyte Balance
Morbidity
Drainage
Ventricular Pressure
Cardiopulmonary Bypass
Catheterization
Blood Pressure
Pressure

Keywords

  • Diastole
  • Fontan procedure
  • Hemodynamics
  • Mechanics
  • Morbidity

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural effusions after the fontan operation. / Garofalo, Cara A.; Cabreriza, Santos E.; Quinn, T. Alexander; Weinberg, Alan D.; Printz, Beth F.; Hsu, Daphne T.; Quaegebeur, Jan M.; Mosca, Ralph S.; Spotnitz, Henry M.

In: Circulation, Vol. 114, No. SUPPL. 1, 07.2006.

Research output: Contribution to journalArticle

Garofalo, CA, Cabreriza, SE, Quinn, TA, Weinberg, AD, Printz, BF, Hsu, DT, Quaegebeur, JM, Mosca, RS & Spotnitz, HM 2006, 'Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural effusions after the fontan operation', Circulation, vol. 114, no. SUPPL. 1. https://doi.org/10.1161/CIRCULATIONAHA.105.001396
Garofalo, Cara A. ; Cabreriza, Santos E. ; Quinn, T. Alexander ; Weinberg, Alan D. ; Printz, Beth F. ; Hsu, Daphne T. ; Quaegebeur, Jan M. ; Mosca, Ralph S. ; Spotnitz, Henry M. / Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural effusions after the fontan operation. In: Circulation. 2006 ; Vol. 114, No. SUPPL. 1.
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T1 - Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural effusions after the fontan operation

AU - Garofalo, Cara A.

AU - Cabreriza, Santos E.

AU - Quinn, T. Alexander

AU - Weinberg, Alan D.

AU - Printz, Beth F.

AU - Hsu, Daphne T.

AU - Quaegebeur, Jan M.

AU - Mosca, Ralph S.

AU - Spotnitz, Henry M.

PY - 2006/7

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N2 - BACKGROUND - We validated the clinical relevance of ventricular stiffness by examining surgical morbidity in children with univentricular hearts undergoing Fontan operation. We hypothesized that ventricular stiffness affects Fontan morbidity, particularly duration of pleural effusions. METHODS AND RESULTS - Sixteen children with right ventricular (RV) (n =11) or left ventricular (LV) (n =5) dominance were studied intraoperatively at a median age of 3.3 years (1.8 to 5.1). Transesophageal long-axis echocardiograms and ventricular pressure by micromanometer provided end-diastolic pressure (P) area (A) relations during initiation and conclusion of cardiopulmonary bypass. Curve fitting to the equation P=αe defined the ventricular stiffness constant, β. Changes in β and clinical correlations were examined. Ventricular stiffness increased after bypass in patients with complete pre-bypass and post-bypass data (n =11, P=0.023, mixed models methodology). Pre-bypass β correlated well with duration of chest tube (CT) drainage (r=0.90, n =16), net perioperative fluid balance (r=0.71, n=14), and length of stay (LOS) (r=0.81, n =16). CT duration and LOS also correlated significantly with post-bypass β (r=0.77 for both, n=11), but insignificantly with preoperative catheterization pressures. CONCLUSIONS - Intraoperative β predicts duration of CT drainage, net perioperative fluid balance, and LOS after the Fontan operation. These observations could improve risk stratification and clinical management of children at high-risk undergoing the Fontan operation.

AB - BACKGROUND - We validated the clinical relevance of ventricular stiffness by examining surgical morbidity in children with univentricular hearts undergoing Fontan operation. We hypothesized that ventricular stiffness affects Fontan morbidity, particularly duration of pleural effusions. METHODS AND RESULTS - Sixteen children with right ventricular (RV) (n =11) or left ventricular (LV) (n =5) dominance were studied intraoperatively at a median age of 3.3 years (1.8 to 5.1). Transesophageal long-axis echocardiograms and ventricular pressure by micromanometer provided end-diastolic pressure (P) area (A) relations during initiation and conclusion of cardiopulmonary bypass. Curve fitting to the equation P=αe defined the ventricular stiffness constant, β. Changes in β and clinical correlations were examined. Ventricular stiffness increased after bypass in patients with complete pre-bypass and post-bypass data (n =11, P=0.023, mixed models methodology). Pre-bypass β correlated well with duration of chest tube (CT) drainage (r=0.90, n =16), net perioperative fluid balance (r=0.71, n=14), and length of stay (LOS) (r=0.81, n =16). CT duration and LOS also correlated significantly with post-bypass β (r=0.77 for both, n=11), but insignificantly with preoperative catheterization pressures. CONCLUSIONS - Intraoperative β predicts duration of CT drainage, net perioperative fluid balance, and LOS after the Fontan operation. These observations could improve risk stratification and clinical management of children at high-risk undergoing the Fontan operation.

KW - Diastole

KW - Fontan procedure

KW - Hemodynamics

KW - Mechanics

KW - Morbidity

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