Effect of volume unloading surgery on coronary flow dynamics in patients with aortic atresia

M. A. Fogel, J. Rychik, J. Vetter, M. T. Donofrio, Marshall L Jacobs, T. Geva

Research output: Contribution to journalArticle

Abstract

Objectives: The objectives of this study were to define physiologic effects on and a clinical correlate to coronary blood flow during volume unloading surgery in patients with aortic atresia. Methods: Twenty-two patients with aortic atresia (group 1, 13 patients with stage I reconstruction undergoing hemi-Fontan operation; group II, 9 patients with hemi-Fontan undergoing Fontan operation) underwent perioperative transesophageal echocardiography. Doppler spectral patterns, peak velocity, velocity time integral, and blood flow in the native ascending aorta were measured. Preoperative hemodynamics and postoperative clinical data were analyzed. Significance was defined as p <0.05. Results: Higher values of coronary blood flow (982.9 ± 321.7 vs 548.6 ± 333.8 ml/min per square meter), velocity time integral (20.7 ± 5.6 vs 12.6 ± 4.0 cm), and peak velocity (96.1 ± 21.4 vs 51.0 ± 18.2 cm/sec) were found before operation in group I than after operation and in group II at both times. Flow changed from predominately systolic in preoperative group I to both systolic and diastolic after operation and in group II. Before operation in groups I and II, a number of hemodynamic parameters such as superior vena cava oxygen saturation correlated with coronary blood flow dynamics. After operation in group II, urine output (r = 0.86) and central venous pressure (r = -0.85) correlated with coronary blood flow dynamics. Conclusion: Coronary blood flow parameters were higher in group 1 as a result of the increased energy needs required to pump to two circulations. No changes were found in group II. A number of coronary blood flow parameters correlated with preoperative hemodynamics and postoperative clinical data. These parameters appear to be useful in assessing the performance status of the myocardium after the Fontan operation, consistent with the notion that myocardial perfusion relates directly to ventricular function.

Original languageEnglish (US)
Pages (from-to)718-727
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume113
Issue number4
DOIs
StatePublished - 1997
Externally publishedYes

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Fontan Procedure
Hemodynamics
Central Venous Pressure
Superior Vena Cava
Ventricular Function
Transesophageal Echocardiography
Aorta
Myocardium
Perfusion
Urine
Oxygen

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Effect of volume unloading surgery on coronary flow dynamics in patients with aortic atresia. / Fogel, M. A.; Rychik, J.; Vetter, J.; Donofrio, M. T.; Jacobs, Marshall L; Geva, T.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 113, No. 4, 1997, p. 718-727.

Research output: Contribution to journalArticle

Fogel, M. A. ; Rychik, J. ; Vetter, J. ; Donofrio, M. T. ; Jacobs, Marshall L ; Geva, T. / Effect of volume unloading surgery on coronary flow dynamics in patients with aortic atresia. In: Journal of Thoracic and Cardiovascular Surgery. 1997 ; Vol. 113, No. 4. pp. 718-727.
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