Abstract:
:BACKGROUND. The fenestrated Fontan operation has been applied to high-risk patients with univentricular hearts, resulting in improved survival. The purpose of this study was to determine the hemodynamic factors responsible for these improved results. METHODS AND RESULTS. We performed the fenestrated Fontan operation in 17 high-risk patients with univentricular hearts (median age, 3 years; age range, 1.2-25 years). High-risk characteristics were depressed ventricular function and/or hypertrophy (n = 12), atrioventricular valve insufficiency (n = 5), pulmonary artery distortion (n = 6), elevated pulmonary vascular resistance (> 2 units/m2) (n = 4), previously failed Fontan operation (n = 2), or associated Wolff-Parkinson-White syndrome (n = 1). Intraoperative hemodynamic measurements (n = 8) included cardiac index (by aortic flow probe), peripheral arterial O2 saturations, and left and right atrial pressures during inflow occlusion, followed by volume loading with open versus closed fenestration. Mean baffle fenestration was 3.5 mm (range, 2.7-5.0 mm). Multiple regression analysis (cardiac index versus atrial pressure) revealed cardiac index was greater with open than with closed fenestration (p < 0.001) during volume loading. Oxygen delivery (cardiac index multiplied by oxygen content) was also greater with open than with closed fenestration (p < 0.001). Survival was 100% with a mean follow-up of 10.4 months; pleural drainage was high in two patients. Subsequent transcatheter fenestration closure resulted in increased O2 saturation (87 +/- 1% to 96 +/- 0.3%, p < 0.05). CONCLUSIONS. The fenestrated Fontan operation improves survival in high-risk patients by increasing cardiac index and maintaining oxygen delivery, despite mild arterial O2 desaturation. Subsequent transcatheter fenestration closure can be performed after hemodynamic assessment.
journal_name
Circulationjournal_title
Circulationauthors
Mavroudis C,Zales VR,Backer CL,Muster AJ,Latson LAsubject
Has Abstractpub_date
1992-11-01 00:00:00pages
II85-92issue
5 Suppleissn
0009-7322issn
1524-4539journal_volume
86pub_type
杂志文章相关文献
CIRCULATION文献大全abstract:BACKGROUND:Little is known of the prognostic significance of mitral regurgitation (MR) on transcatheter aortic valve replacement (TAVR), the impact of TAVR on MR severity, and the variables associated with possible post-TAVR improvement in MR. We evaluated these issues in a multicenter registry of patients undergoing C...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCULATIONAHA.113.001822
更新日期:2013-11-05 00:00:00
abstract:BACKGROUND:Left ventricular wall motion (WM) abnormalities have recognized prognostic significance in patients with coronary or other heart diseases; however, whether abnormal WM predicts adverse events in adults without overt cardiovascular disease has not been assessed. Our objective was to determine whether echocard...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.106.652149
更新日期:2007-07-10 00:00:00
abstract:BACKGROUND:Pharmacogenetic-guided dosing of warfarin is a promising application of "personalized medicine" but has not been adequately tested in randomized trials. METHODS AND RESULTS:Consenting patients (n=206) being initiated on warfarin were randomized to pharmacogenetic-guided or standard dosing. Buccal swab DNA w...
journal_title:Circulation
pub_type: 杂志文章,随机对照试验
doi:10.1161/CIRCULATIONAHA.107.737312
更新日期:2007-11-27 00:00:00
abstract:BACKGROUND:The purpose of this study was to compare differential effects of a segment of slow conduction during ventricular tachycardia (VT) due to depression of the action potential and electrical uncoupling. METHODS AND RESULTS:In 33 Langendorff-perfused rabbit hearts, a ring of anisotropic left ventricular subepica...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.99.7.949
更新日期:1999-02-23 00:00:00
abstract:BACKGROUND:Apolipoprotein E (apoE) has long been known to play an important role in the clearance of plasma lipoproteins. More recently, a direct role for apoE in delaying atherogenesis has been proposed. Macrophage production of apoE in the artery wall has been demonstrated to provide protection against atheroscleroti...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.99.19.2571
更新日期:1999-05-18 00:00:00
abstract:BACKGROUND:Coronary heart disease (CHD) represents the largest share of cardiovascular disease in the United States, but there are conspicuous discrepancies between CHD and total cardiovascular death rates across the states, possibly due in part to variations in physician assignment of causes of death. Our aim was to i...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.105.595777
更新日期:2006-05-02 00:00:00
abstract:BACKGROUND:Production of NO by inducible NO synthase (iNOS) has been implicated in the pathology of spontaneous and antigen-induced autoimmune diseases, and iNOS is expressed in the myocardium of patients with heart failure. It is not clear whether inflammatory murine autoimmune heart disease, an experimental model for...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1997-07-15 00:00:00
abstract:BACKGROUND:Roux-en-Y gastric bypass (RYGB) reduces body weight and cardiovascular mortality in morbidly obese patients. Glucagon-like peptide-1 (GLP-1) seems to mediate the metabolic benefits of RYGB partly in a weight loss-independent manner. The present study investigated in rats and patients whether obesity-induced ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.114.011791
更新日期:2015-03-10 00:00:00
abstract:BACKGROUND:Mild oxidation of LDL enhances its atherogenic potential and induces a synergistic interaction with serotonin (5HT) on vascular smooth muscle cell (VSMC) proliferation. Because of its complex chemical nature, the mitogenic components of mildly oxidized LDL (moxLDL) remain unclear. METHODS AND RESULTS:We exa...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.103.10.1440
更新日期:2001-03-13 00:00:00
abstract::Optimal electrode position for long-term transvenous cardiac pacing is in the apex of the right ventricle. Intracardiac electrograms, surface electrocardiograms, frontal fluoroscopy, lateral roentgenograms, and pacing threshold levels were studied in two groups of patients: One group was comprised of five patients wit...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.42.4.701
更新日期:1970-10-01 00:00:00
abstract:BACKGROUND:It has recently been shown that mitochondrial aldehyde dehydrogenase 2 (mtALDH) catalyzes the formation of 1,2-glyceryl dinitrate and nitrite from nitroglycerin (glyceryl trinitrate [GTN]) within mitochondria, leading to production of cGMP and vasorelaxation. However, whether this mechanism operates in the s...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000138105.17864.6B
更新日期:2004-08-10 00:00:00
abstract:BACKGROUND:Although surgery is indicated in patients with mitral regurgitation (MR) when left ventricular (LV) end-systolic (LVES) dimension is >40 mm, LV ejection fraction may decrease after mitral valve surgery. We hypothesize that significant LV remodeling before surgery is not reflected by standard echocardiographi...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.111.073239
更新日期:2012-05-15 00:00:00
abstract:BACKGROUND:CXCL16/SR-PSOX is an interferon-gamma-regulated chemokine and scavenger receptor for oxidized low-density lipoprotein that is expressed in atherosclerotic lesions. Proteolytic cleavage of membrane-bound CXCL16 releases soluble CXCL16, which may promote migration of effector T cells and augment a proatherogen...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.108.806877
更新日期:2009-06-30 00:00:00
abstract:BACKGROUND:Vascular inflammation and lipid deposition are prominent features of atherosclerotic lesion formation. We have shown previously that the dithiol compound alpha-lipoic acid (LA) exerts antiinflammatory effects by inhibiting tumor necrosis factor-alpha- and lipopolysaccharide-induced endothelial and monocyte a...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.107.725275
更新日期:2008-01-22 00:00:00
abstract::Plasma and lipoprotein cholesterol and triglyceride concentrations were measured in Pima Indians, a genetically homogeneous population with a high prevalence of obesity and diabetes and a low frequency of coronary heart disease. The data for nondiabetic Pima Indians were compared with those of U.S. Caucasians measured...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.68.4.714
更新日期:1983-10-01 00:00:00
abstract:BACKGROUND:Isoprostanes (iPs) are free radical-catalyzed products of arachidonic acid that reflect lipid peroxidation in vivo. Several iPs exert biological effects in vitro and may contribute to the functional consequences of oxidant stress. For example, iPF(2alpha)-III (8-iso PGF(2alpha)) and iPE(2)-III modulate plate...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.101.24.2833
更新日期:2000-06-20 00:00:00
abstract:BACKGROUND:The regulation of the cardiac neutral endopeptidase (EC 24.10, NEP) that degrades bradykinin and natriuretic peptides has been investigated in human cardiac hypertrophy and heart failure. Methods and Results- NEP mRNA was quantitated by real-time polymerase chain reaction (PCR) in left ventricular biopsies f...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/hc0302.103593
更新日期:2002-01-22 00:00:00
abstract:BACKGROUND:Insulin sensitivity varies up to threefold in apparently healthy individuals, but the mechanism for this is unknown. We have examined the hypothesis that vascular endothelial nitric oxide production and insulin sensitivity are directly related in humans. METHODS AND RESULTS:Nineteen healthy male subjects we...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.93.7.1331
更新日期:1996-04-01 00:00:00
abstract:BACKGROUND:The cardiovascular adaptation to bed rest leads to orthostatic intolerance, characterized by an excessive fall in stroke volume (SV) in the upright position. We hypothesized that this large fall in SV is due to a change in cardiac mechanics. METHODS AND RESULTS:We measured pulmonary capillary wedge pressure...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.96.2.517
更新日期:1997-07-15 00:00:00
abstract:BACKGROUND:Eplerenone is known to reduce time to first hospitalization for heart failure or cardiovascular death in patients with heart failure and mild symptoms. In chronic diseases such as heart failure, characterized by repeat hospitalizations, analyzing all heart failure hospitalizations, not just the first, should...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.112.110536
更新日期:2012-11-06 00:00:00
abstract::Atherosclerotic cardiovascular disease results in >19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior sympto...
journal_title:Circulation
pub_type: 共识发展会议,杂志文章,评审
doi:10.1161/01.CIR.0000087481.55887.C9
更新日期:2003-10-14 00:00:00
abstract:BACKGROUND:We conducted a 10-year follow-up of the 11 712 patients with acute myocardial infarction randomized in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto-1 study, the first large trial assessing thrombolytic therapy. METHODS AND RESULTS:Information on survival at 10 years was obtained for th...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.98.24.2659
更新日期:1998-12-15 00:00:00
abstract::Resting hemodynamics improve during vasodilator administration in patients, with congestive heart failure (CHF), but the effects of these agents on exercise is unknown. Twenty-two patients with class II or III CHF performed bicycle exercise to symptomatic maximum before and 90 minutes after random double-blind adminis...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.59.6.1085
更新日期:1979-06-01 00:00:00
abstract:BACKGROUND:Insulin modulates sympathetic vasoconstriction, but the mechanisms underlying this effect are not completely elucidated. We have recently investigated the insulin effect on the alpha 1- and alpha 2-adrenergic vasoconstriction pathway, where it is still conflicting with the possible insulin influence on the b...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.93.7.1403
更新日期:1996-04-01 00:00:00
abstract:BACKGROUND:Peak dP/dt is a good index of ventricular performance that is not influenced by afterload, wall motion abnormalities, or the variations in ventricular anatomy and morphology commonly encountered among patients with congenital heart disease. Unfortunately, the clinical utility of peak dP/dt has been limited b...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.88.6.2693
更新日期:1993-12-01 00:00:00
abstract:BACKGROUND:The impact of misinterpretation of the ECG in patients with acute myocardial infarction (AMI) in the emergency department (ED) setting is not well known. Our goal was to assess the prevalence of the failure to identify high-risk ECG findings in ED patients with AMI and to determine whether this failure is as...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCULATIONAHA.106.623652
更新日期:2006-10-10 00:00:00
abstract:BACKGROUND:Despite early recanalization of an occluded infarct artery, reperfusion at the level of the microcirculation may remain impaired owing to a process of microvascular reperfusion injury. METHODS AND RESULTS:Microvascular reperfusion injury was studied in 91 patients with acute myocardial infarction (AMI) by e...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.99.15.1972
更新日期:1999-04-20 00:00:00
abstract:BACKGROUND:Cellular transplantation is emerging as a promising strategy for the treatment of postinfarction ventricular dysfunction. Whether its beneficial effects can be extended to other cardiomyopathies remains an unexplored question. We evaluated the histological and functional effects of simultaneous autologous tr...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.105.000646
更新日期:2006-07-04 00:00:00
abstract:BACKGROUND:In patients with symptoms of heart failure, elevations in B-type natriuretic peptide (BNP) accurately identify ventricular dysfunction. However, BNP levels are not specific for ventricular dysfunction in patients who do not have overt symptoms of heart failure, suggesting that other cardiac processes such as...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000103681.04726.9C
更新日期:2003-12-16 00:00:00
abstract::Twenty-two patients who underwent anatomic correction of transposition of the great arteries at the arterial level at the age of 8 weeks to 14 years were reinvestigated 1-4.6 years (mean 2.0 years) after operation. A Dacron tube was used to bridge the gap between the proximal pulmonary route and the distal pulmonary a...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1982-08-01 00:00:00