Hirofumi Saiki1, Clara Kurishima1, Satoshi Masutani1, Hideaki Senzaki2. 1. Department of Pediatric Cardiology and Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan. 2. Department of Pediatric Cardiology and Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan. Electronic address: hsenzaki@saitama-med.ac.jp.
Abstract
BACKGROUND: Information about the cerebral circulation in the Fontan physiology is scarce. We tested our hypothesis that cerebral perfusion is impaired in the Fontan circulation by analyzing wavefront behavior (wave intensity) and assessing arterial stiffness at the carotid artery. METHODS: The carotid arterial wave intensity and stiffness were computed in 34 consecutive Fontan patients (11.5±8.6 years) and 20 control subjects (13.4±6.0 years) using an echocardiographic vascular tracking system, which enabled simultaneous measurements of instantaneous carotid arterial pressure and flow velocity. RESULTS: The carotid arterial blood flow was significantly lower in the Fontan patients than in the controls (p<0.05). Wave intensity analysis demonstrated a significant decrease in the compression and acceleration wave, an important forward traveling wave for cerebral circulation, in the Fontan patients compared with the control subjects (31.0±2.6 versus 48.1±4.4 mm Hg⋅m⋅s3⋅10(3); p=0.001). In addition, the negative wave intensity normalized to the first positive wave, representing a wave reflection from peripheral cerebral vessels, was significantly increased in the Fontan patients compared with that in control subjects. Carotid arterial stiffness and central venous pressure were also significantly increased in the Fontan patients and were independent determinants of the decreased first positive wave, suggesting the pathophysiologic importance of carotid arterial stiffness and central venous pressure as inflow and outflow resistance to the cerebral circulation, respectively, in the Fontan physiology. CONCLUSIONS: These results suggest impaired cerebral perfusion caused by vascular stiffening and high central venous pressure in patients with Fontan circulation. Longitudinal studies examining the association between cerebral circulation and neurodevelopmental outcome after Fontan operation are warranted.
BACKGROUND: Information about the cerebral circulation in the Fontan physiology is scarce. We tested our hypothesis that cerebral perfusion is impaired in the Fontan circulation by analyzing wavefront behavior (wave intensity) and assessing arterial stiffness at the carotid artery. METHODS: The carotid arterial wave intensity and stiffness were computed in 34 consecutive Fontan patients (11.5±8.6 years) and 20 control subjects (13.4±6.0 years) using an echocardiographic vascular tracking system, which enabled simultaneous measurements of instantaneous carotid arterial pressure and flow velocity. RESULTS: The carotid arterial blood flow was significantly lower in the Fontan patients than in the controls (p<0.05). Wave intensity analysis demonstrated a significant decrease in the compression and acceleration wave, an important forward traveling wave for cerebral circulation, in the Fontan patients compared with the control subjects (31.0±2.6 versus 48.1±4.4 mm Hg⋅m⋅s3⋅10(3); p=0.001). In addition, the negative wave intensity normalized to the first positive wave, representing a wave reflection from peripheral cerebral vessels, was significantly increased in the Fontan patients compared with that in control subjects. Carotid arterial stiffness and central venous pressure were also significantly increased in the Fontan patients and were independent determinants of the decreased first positive wave, suggesting the pathophysiologic importance of carotid arterial stiffness and central venous pressure as inflow and outflow resistance to the cerebral circulation, respectively, in the Fontan physiology. CONCLUSIONS: These results suggest impaired cerebral perfusion caused by vascular stiffening and high central venous pressure in patients with Fontan circulation. Longitudinal studies examining the association between cerebral circulation and neurodevelopmental outcome after Fontan operation are warranted.
Authors: Miriam Michel; Karl-Otto Dubowy; Manuela Zlamy; Daniela Karall; Mark Gordian Adam; Andreas Entenmann; Markus Andreas Keller; Jakob Koch; Irena Odri Komazec; Ralf Geiger; Christina Salvador; Christian Niederwanger; Udo Müller; Sabine Scholl-Bürgi; Kai Thorsten Laser Journal: Ther Adv Chronic Dis Date: 2020-04-27 Impact factor: 5.091
Authors: Lisette M Harteveld; Nico A Blom; J Gert van Dijk; Robert H Reijntjes; Paul J van Someren; Fabian I Kerkhof; Irene M Kuipers; Lukas A J Rammeloo; Eco J C de Geus; Arend D J Ten Harkel Journal: PLoS One Date: 2022-09-01 Impact factor: 3.752