Clinical investigationsTotal vascular resistance increases during volume-unloading in asymptomatic single ventricle patients
Section snippets
Materials and methods
A retrospective review was conducted at our institution of all patients with SV heart disease who presented to the cardiac catheterization lab for routine hemodynamic evaluation. Symptomatic patients (eg, patients who underwent catheterization to address acute or chronic decompensation, heart failure, or other important hemodynamic perturbations [e.g. severe cyanosis]) were not included in the current study. Patients born from January 2002 through June 2016 were included regardless of where
Results
During the study period, 372 patients with single ventricle heart disease underwent routine cardiac catheterization to assess hemodynamics, with 310 Stage I, 243 Stage II and 113 Stage III catheterizations at a median age of 4.4 months (25th-75th 3.3-5.8 months), 2.7 years (25th-75th 1.9-3.9 years) and 7.3 years (25th-75th 5.3-9.6 years), respectively (Table I). The most common cardiac diagnosis among the cohort was tricuspid atresia (35.2% of Stage I cohort), followed by unbalanced complete
Discussion
In our study of asymptomatic children with single ventricle heart disease, we found that TVR increases dramatically with the staged uncoupling of the pulmonary and systemic circulations. Systemic vascular resistance comprises the larger component of TVR, by far, and is responsible for the high TVR faced by the single ventricle following Stage III palliation. Interestingly, although use of systemic vasodilators was common in patients following Stage III palliation, we found no association
Limitations
Our study was limited by several factors. This was a retrospective study of all single ventricle patients undergoing routine catheterization. As a rule, some of these patients may have had significant alterations in hemodynamics preceding the catheterization or brought about by use of general endotracheal anesthesia. Use of an assumed oxygen consumption (VO2) provides an approximation, likely varying in precision by patient.
Finally, we were also unable to account for systemic to pulmonary
Conclusion
TVR steadily increases with an increasing contribution from SVR over progressive stages. The increase in TVR is reduced in Stage III patients on SVR-lowering medication and approaches statistical significance. TVR does not correlate with echo-based indices of SV systolic or valve function. Further studies are needed to see if functional exercise capacity can be more effectively modulated by modifying SVR as opposed to PVR.
Credit statement
Danish Vaiyani: Conceptualization, Investigation, Writing – Original Draft, Visualization. Kumiyo Matsuo: Investigation, Methodology, Writing – Review & Editing. Usama Kanaan: Conceptualization, Methodology, Writing – Review & Editing. Bhavesh Patel: Investigation, Writing – Review & Editing. Olalade Akintoye: Investigation, Methodology, Writing – Review & Editing. Curtis D Travers: Methodology, Software, Formal Analysis, Visualization. Michael Kelleman: Methodology, Software, Formal Analysis,
Declaration of competing interest
None.
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