RESEARCH PAPER
Non-invasive assessment of haemodynamic parameters in patients after Fontan procedure
 
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1
University Centre for Cardiology, Department of Family Medicine, Medical University, Gdansk, Poland
2
Department of Paediatric Cardiology and Congenital Heart Diseases, Medical University, Gdansk, Poland
CORRESPONDING AUTHOR
Joanna Kwiatkowska   

Department of Paediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, Poland
 
KEYWORDS
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ABSTRACT
Introduction and objective:
Single ventricle anomaly is one of the complex congenital heart defects. A dependable non-invasive method of evaluation of Fontan circulation haemodynamics for early diagnosing unstable patients is hardly available in routine clinical practice. The aim of the study is non-invasive evaluation of the haemodynamic parameters in patients after Fontan operation.

Material and methods:
The study involved 11 participants (age 24.4±4.3 years) with functionally univentricular hearts after Fontan operation. Evaluation of haemodynamic parameters was performed in supine and sitting positions using the impedance cardiography method.

Results:
In comparative analysis, heart rate (70.1 vs.78.3 1/min; p=0.001), diastolic blood pressure (73.9 vs. 76.7 mm Hg; p=0.026), mean arterial blood pressure (84.5 vs. 88.0 mm Hg; p=0.013), systemic vascular resistance (1284.8 vs. 1334.9 dyn*s*cm-5; p=0.024), systemic vascular resistance index (2178.7 vs. 2272.8 dyn*s*cm-5*m2 ; p=0.018), pre-ejection period (124.2 vs. 136.2 ms; p=0.009), systolic time ratio (0.43 vs. 0.53; p=0.0001), and Zo (26.2 vs. 28.7 Ω; p<0.00001), were significantly higher in the sitting position. Stroke volume (75.4 vs. 68.5 ml; p=0.013), stroke index (42.7 vs. 39.0 ml*m-2; p=0.014), thoracic fluid content (38.5 vs. 35.4 1*kΩ-1; p=<0.00001), thoracic fluid content index (22.8 vs. 21.0 1*kΩ-1*m-2; p=<0.00001), and leftventricular ejection time 291.1 vs. 260.1 ms; p <0.00001, were significantly higher in the supine position.

Conclusions:
In patients after Fontan procedure, impedance cardiography can be a useful tool the assessment of shortterm haemodynamic changes provoked by postural changes. Its clinical value in patients with congenital heart defects should be further investigated.

ACKNOWLEDGEMENTS
The study was conducted in accordance with the principles of Good Clinical Practice and the Declaration of Helsinki, with the approval of the local Bioethics Committee (Approval No. NKEBN/232/08). The study was financed by the Medical University of Gdansk (ST-72).
 
REFERENCES (25)
1.
Jacobs JP, Maruszewski B. Functionally Univentricular Heart and the Fontan Operation. World J Pediatr Congenit Heart Surg. 2013; 4(4): 349–55.
 
2.
Rowland TW. The circulatory response to exercise: Role of the peripheral pump. Int J Sports Med 2001; 22(8): 558–565.
 
3.
Cordina RL, O’Meagher S, Karmali A, Rae CL, Liess C, Kemp GJ, et al. Resistance training improves cardiac output, exercise capacity and tolerance to positive airway pressure in Fontan physiology. Int J Cardiol. 2013; 8(2): 780–8.
 
4.
Iyengar AJ, Winlaw DS, Galati JC, Wheaton GR, Gentles TL, Grigg LE, et al. The extracardiac conduit Fontan procedure in Australia and New Zealand: Hypoplastic left heart syndrome predicts worse early and late outcomes. Eur J Cardiothorac Surg. 2014; 46(3): 465–73.
 
5.
Ono M, Kasnar-Samprec J, Hager A, Cleuziou J, Burri M, Langenbach C, et al. Clinical outcome following total cavopulmonary connection: A 20-year single-centre experience. Eur J Cardiothorac Surg. 2016; 50(4): 632–641.
 
6.
Petko M, Myung RJ, Wernovsky G, Cohen MI, Rychik J, Nicolson SC, et al. Surgical reinterventions following the Fontan procedure. Eur J Cardiothorac Surg. 2003; 24(2): 255–9.
 
7.
Gewillig M, Goldberg DJ. Failure of the fontan circulation. Heart Fail Clin. 2014; 10(1): 105–16.
 
8.
Pundi KN, Johnson JN, Dearani JA, Pundi KN, Li Z, Hinck CA, et al. 40-Year Follow-Up after the Fontan Operation: Long-Term Outcomes of 1,052 Patients. J Am Coll Cardiol. 2015; 66(15): 1700–10.
 
9.
Beck R, Milella L, Labellarte C. Continuous non-invasive measurement of stroke volume and cardiac index in infants and children: comparison of Impedance Cardiography NICaS® vs CardioQ® method. Clin Ter. 2018; 169(3): e110–e113.
 
10.
Yoshitake S, Miyamoto T, Tanaka Y, Naito Y. Non-invasive measurement of cardiac output using AESCULON® mini after Fontan operation. Pediatr Int. 2017; 59(2): 141–144.
 
11.
Beck R, Milella L, Labellarte C. Continuous noninvasive measurement of stroke volume and cardiac index in infants and children: comparison of Impedance Cardiography NICaS ® vs CardioQ® method. Clin Ter. 2018; 169(3): e110–e113.
 
12.
Charloux A, Lonsdorfer-Wolf E, Richard R, Lampert E, OswaldMammosser M, Mettauer B, et al. A new impedance cardiograph device for the non-invasive evaluation of cardiac output at rest and during exercise: comparison with the “direct” Fick method. Eur J Appl Physiol. 2000; 82(4): 313–20.
 
13.
Lorne E, Mahjoub Y, Diouf M, Sleghem J, Buchalet C, Guinot P-G, et al. Accuracy of impedance cardiography for evaluating trends in cardiac output: a comparison with oesophageal Doppler. Br J Anaesth. 2014; 113(4): 596–602.
 
14.
Appel PL, Kram HB, Mackabee J, Fleming AW, Shoemaker WC. Comparison of measurements of cardiac output by bioimpedance and thermodilution in severely ill surgical patients. Crit Care Med. 1986; 14(11): 933–5.
 
15.
Krzesiński P, Gielerak G, Kowal J. Impedance cardiography – a modern tool for monitoring therapy of cardiovascular diseases. Kardiol Pol. 2009; 67(1): 65–71.
 
16.
Poliner LR, Dehmer GJ, Lewis SE, Parkey RW, Blomqvist CG, Willerson JT. Left ventricular performance in normal subjects: a comparison of the responses to exercise in the upright and supine positions. Circulation. 1980; 62(3): 528–34.
 
17.
Egbe AC, Connolly HM, Miranda WR, Ammash NM, Hagler DJ, Veldtman GR, et al. Hemodynamics of Fontan Failure: The Role of Pulmonary Vascular Disease. Circ Heart Fail. 2017; 10(12). pii: e004515.
 
18.
Gewillig M, Goldberg DJ. Failure of the Fontan Circulation. Heart Fail Clin. 2014; 10(1): 105–17.
 
19.
Hebert A, Jensen AS, Mikkelsen UR, Idorn L, Sørensen KE, Thilen U, et al. Hemodynamic causes of exercise intolerance in Fontan patients. Int J Cardiol. 2014; 175(3): 478–83.
 
20.
Legendre A, Guillot A, Ladouceur M, Bonnet D. Usefulness of stroke volume monitoring during upright ramp incremental cycle exercise in young patients with Fontan circulation. Int J Cardiol. 2017; 227: 625– 630.
 
21.
Ley S, Puderbach M, Risse F, Ley-Zaporozhan J, Eichinger M, Takenaka D, et al. Impact of oxygen inhalation on the pulmonary circulation: Assessment by magnetic resonance (MR)-perfusion and MR-flow measurements. Invest Radiol. 2007; 42(5): 283–90.
 
22.
Körperich H, Müller K, Barth P, Gieseke J, Haas N, Schulze-Neick I, et al. Differentiation of Impaired from Preserved Hemodynamics in Patients with Fontan Circulation Using Real-time Phase-velocity Cardiovascular Magnetic Resonance. J Thorac Imaging. 2017; 32(3): 159–168.
 
23.
Thompson B, Drazner MH, Dries DL, Yancy CW. Systolic Time Ratio by Impedance Cardiography to Distinguish Preserved vs Impaired Left Ventricular Systolic Function in Heart Failure. Congest Heart Fail. 2008; 14(5): 261–5.
 
24.
Castellanos LR, Bhalla V, Isakson S, Daniels LB, Bhalla MA, Lin JP, et al. B-Type Natriuretic Peptide and Impedance Cardiography at the Time of Routine Echocardiography Predict Subsequent Heart Failure Events. J Card Fail. 2009; 15(1): 41–7.
 
25.
Siedlecka J, Siedlecki P, Bortkiewicz A. Impedance cardiography – Old method, new opportunities. Part I. Clinical applications. Int J Occup Med Environ Health. 2015; 28(1): 27–33.
 
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