scholarly journals Superior vena cava flow in newborn infants: a novel marker of systemic blood flow

2000 ◽  
Vol 82 (3) ◽  
pp. 182F-187 ◽  
Author(s):  
M. Kluckow
Keyword(s):  
Blood Flow ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Newborn Infants ◽  
Vena Cava ◽  
Systemic Blood ◽  
Systemic Blood Flow

scholarly journals Evaluation of Optimization of Pulmonary and Systemic Blood Flow in Children after Bidirectional Cavapulmonary Anastomosis

2021 ◽  
pp. 57-62
Author(s):  
Ivan V. Dziuryi ◽  
Iaroslav P. Truba ◽  
Liliya M. Prokopovych ◽  
Vasyl V. Fylypchuk ◽  
Vasyl V. Lazoryshynets
Keyword(s):  
Blood Flow ◽  
Oxygen Saturation ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Flow Ratio ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Blood Flow Ratio ◽  
Systemic Oxygen

In patients after bidirectional cavapulmonary anastomosis, blood flow through the superior vena cava (SVC), providing effective pulmonary blood flow, is the most important factor influencing blood oxygen saturation. Blood flow through the inferior vena cava recirculates into the systemic bloodstream. The study of the ratio of these flows will provide better understanding of the physiology of blood circulation after anastomosis and determine systemic oxygen saturation of blood and optimal time to perform surgery.   The aim. To determine volumetric blood flow in the SVC, calculate pulmonary to systemic blood flow ratio in children after bidirectional cavapulmonary anastomosis, and evaluate its contribution to cardiac output and oxygen saturation in systemic blood flow. Materials and methods. In the period from January 2010 to June 2021, 51 patients with congenital heart defects with depleted pulmonary blood flow underwent hemodynamic correction at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 29 male patients (57%) and 22 female patients (43%). The mean age of the patients at the time of the surgery was 34 ± 18.2 months (2 to 120 months), the mean age of patients at the time of examination was 43.5 ± 28.4 months (12 to 134 months). The main method of diagnosis in determining the defect and assessing the immediate and long-term results was echocardiographic examination and probing of the heart cavities. To evaluate the optimization of pulmonary/systemic blood flow we used equations obtained using the Fick method. Pulmonary to systemic blood flow ratio was calculated separately for 35 patients. Among the examined 35 patients, 18 children were older than 2.5 years, so all the examined patients were conveniently divided into 2 age groups: I group (n = 17) up to 2.5 years, II group (n = 18) older than 2.5 years to assess the contribution of SVC to the systemic circulation depending on age. Results. Pulmonary to systemic blood flow ratio was calculated for 35 patients Qp/Qs = (82% – 66%) / (97% – 66%) = 0.52. The calculated cardiac index according to echocardiography was 4.0 ± 0.85 L/min/m2 which corresponds to the SVC saturation (r = 0.60, p = <0.001). The flow in the superior vena cava = 2.08 L/min/m2. There was a very interesting trend towards decrease in the average rate of systemic saturation in patients after bidirectional cavapulmonary anastomosis depending on age and duration of surgery. Thus, in 17 patients of group I, the calculated Qp/Qs was (84% – 67%) / (97% – 67%) = 0.57. In patients of group II, the average systemic oxygen saturation was 78 ± 2% (from 65% to 81%). Calculated Qp/Qs for 18 patients of group II = (78% – 66%) / (97% – 66%) = 0.39, which indicates a decrease in pulmonary to systemic ratio with the growth of the child. Decreased systemic saturation after bidirectional cavapulmonary anastomosis in patients with increasing age and body surface area is associated with a decrease in the proportional flow from the superior vena cava. Therefore, in our clinical material, we confirmed the phenomenon of change in pulmonary to systemic ratio depending on age, which was described by Salim et al. according to a study conducted on healthy babies. Conclusions. The contribution of SVC flow to total cardiac output after bidirectional cavapulmonary anastomosis is directly associated with the patient’s age and gradually decreases in older patients, as indicated by a decrease in systemic saturation, so the clinical effect of bidirectional cavapulmonary anastomosis may be significantly better when performing surgery in early childhood.

Cord milking versus immediate clamping in preterm infants: a randomised controlled trial

2018 ◽  
Vol 104 (2) ◽  
pp. F145-F150 ◽  
Author(s):  
Walid El-Naggar ◽  
David Simpson ◽  
Arif Hussain ◽  
Anthony Armson ◽  
Linda Dodds ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Preterm Infants ◽  
Controlled Trial ◽  
Superior Vena ◽  
Tertiary Care ◽  
Vena Cava ◽  
Mean Difference ◽  
Systemic Blood ◽  
Systemic Blood Flow

ObjectiveTo investigate whether umbilical cord milking (UCM) at birth improves systemic blood flow and short-term outcomes, as compared with immediate cord clamping (ICC).DesignRandomised clinical trial.SettingSingle tertiary care centre.PatientsInfants born to eligible women presenting in preterm labour between 24 and 31 weeks’ gestation.InterventionsUCM three times at birth or ICC.Outcome measuresPrimary outcome included systemic blood flow as represented by echo-derived superior vena cava(SVC) flow at 4–6 hours after birth. The echocardiographer and interpreter were blinded to the randomisation. Secondary outcomes included cardiac output, neonatal morbidities and mortality. Analysis was by intention to treat.ResultsA total of 73 infants were randomised (37 to UCM and 36 to ICC). Mean (SD) gestational age was 27 (2) weeks and mean (SD) birth weight was 1040 (283) g. Haemoglobin on admission was higher in the UCM than in the ICC group (16.1 vs 15.0 g/L), p=0.049 (mean difference 1.1, 95% CI 0.003 to 2.2). No statistically significant differences were found between groups in SVC flow at 4–6 hours (88.9±37.8 and 107.3±60.1 mL/kg/min), p=0.13 (mean difference −18.4, 95% CI −41.7 to 5.0 mL/kg/min) or at 10–12 hours of age (102.5±41.8 and 90.6±28.4 mL/kg/min), p=0.17 (mean difference 12.0, 95% CI −4.7 to 28.7 mL/kg/min), cardiac output or neonatal morbidities.ConclusionsCord milking was not shown to improve functional cardiac outcomes, neonatal morbidity or mortality. More research is needed before routine cord milking can be recommended for very preterm infants.Trial registrationNCT01487187.

scholarly journals Postnatal Systemic Blood Flow in Neonates with Abnormal Fetal Umbilical Artery Doppler

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Richelle N. Olsen ◽  
Jennifer Shepherd ◽  
Anup Katheria
Keyword(s):  
Blood Flow ◽  
Umbilical Artery ◽  
Superior Vena ◽  
Vena Cava ◽  
Adverse Outcomes ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Future Studies ◽  
Gestational Age At Delivery ◽  
Umbilical Artery Doppler

Objective. Abnormal umbilical artery Doppler (UAD) studies are associated with poor neonatal outcomes. We sought to determine if postnatal measures of systemic blood flow (SBF), as measured by functional echocardiography (fECHO), could identify which fetuses with abnormal UAD were at the highest risk of adverse outcomes. Study Design. This is a retrospective review of fetuses with abnormal UAD who received fECHO in the first 72 hours of life. Measures of SBF (right ventricular output (RVO) and superior vena cava (SVC) flow) were performed and compared with prenatal variables and postnatal outcomes. Result. 63 subjects had abnormal UAD, 20 of which also had fECHO. Six subjects had abnormal flow. Gestational age at delivery was similar between the two groups. Those with abnormal SBF had fewer days of abnormal UAD prior to delivery and developed RDS (P<0.001). Conclusion. Postnatal measures of SBF were associated with poor postnatal outcomes in fetuses with abnormal UAD. Future studies incorporating antenatal measures of SBF may help obstetricians determine which pregnancies complicated by UAD are likely to have postnatal morbidity.

A Computational Pulsatile Model of the Bidirectional Cavopulmonary Anastomosis: The Influence of Pulmonary Forward Flow

1996 ◽  
Vol 118 (4) ◽  
pp. 520-528 ◽  
Author(s):  
Francesco Migliavacca ◽  
Marc R. de Leval ◽  
Gabriele Dubini ◽  
Riccardo Pietrabissa
Keyword(s):  
Blood Flow ◽  
Pulmonary Artery ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
Similar Distribution ◽  
Pulsatile Blood Flow ◽  
Cavopulmonary Anastomosis ◽  
Bidirectional Cavopulmonary Anastomosis

The bidirectional cavopulmonary anastomosis (BCPA or bidirectional Glenn) is an operation to treat congenital heart diseases of the right heart by diverting the systemic venous return from the superior vena cava to both lungs. The main goal is to provide the correct perfusion to both lungs avoiding an excessive increase in systemic venous pressure. One of the factors which can affect the clinical outcome of the surgically reconstructed circulation is the amount of pulsatile blood flow coming from the main pulmonary artery. The purpose of this work is to analyse the influence of this factor on the BCPA hemodynamics. A 3-D finite element model of the BCPA has been developed to reproduce the flow of the surgically reconstructed district. Geometry and hemodynamic data have been taken from angiocardiogram and catheterization reports, respectively. On the basis of the developed 3-D model, four simulations have been performed with increasing pulsatile blood flow rate from the main pulmonary artery. The results show that hemodynamics in the pulmonary arteries are greatly influenced by the amount of flow through the native main pulmonary artery and that the flow from the superior vena cava allows to have a similar distribution of the blood to both lungs, with a little predilection for the left side, in agreement with clinical postoperative data.

scholarly journals Use of Superior Vena Cava-Right Pulmonary Artery Anastomosis in Congenital Heart Disease with Decreased Pulmonary Blood Flow

Circulation ◽  
1969 ◽  
Vol 40 (6) ◽  
pp. 777-784 ◽  
Author(s):  
IRWIN B. BORUCHOW ◽  
THOMAS D. BARTLEY ◽  
LARRY P. ELLIOTT ◽  
MYRON W. WHEAT ◽  
L. JEROME KROVETZ ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Pulmonary Artery ◽  
Superior Vena Cava ◽  
Pulmonary Blood Flow ◽  
Congenital Heart ◽  
Superior Vena ◽  
Vena Cava ◽  
Right Pulmonary Artery

scholarly journals The Methodology of Doppler-Derived Central Blood Flow Measurements in Newborn Infants

2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Koert A. de Waal
Keyword(s):  
Blood Flow ◽  
Doppler Ultrasound ◽  
Superior Vena ◽  
Ductus Arteriosus ◽  
Newborn Infants ◽  
Vena Cava ◽  
Left Ventricular ◽  
Flow Measurements ◽  
General Guide ◽  
Blood Flow Measurements

Central blood flow (CBF) measurements are measurements in and around the heart. It incorporates cardiac output, but also measurements of cardiac input and assessment of intra- and extracardiac shunts. CBF can be measured in the central circulation as right or left ventricular output (RVO or LVO) and/or as cardiac input measured at the superior vena cava (SVC flow). Assessment of shunts incorporates evaluation of the ductus arteriosus and the foramen ovale. This paper describes the methodology of CBF measurements in newborn infants. It provides a brief overview of the evolution of Doppler ultrasound blood flow measurements, basic principles of Doppler ultrasound, and an overview of all used methodology in the literature. A general guide for interpretation and normal values with suggested cutoffs of CBFs are provided for clinical use.

Hemodynamics Characteristics of a Four-Way Right-Atrium Bypass Connector

2017 ◽  
Author(s):  
Elizabeth Mack ◽  
Alexandrina Untaroiu
Keyword(s):  
Blood Flow ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Superior Vena ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Design Parameters ◽  
Patient Specific ◽  
Optimal Size ◽  
The Right

Currently, the surgical procedure followed by the majority of cardiac surgeons to address right ventricular dysfunction is the Fontan procedure, which connects the superior and inferior vena cava directly to the left and right pulmonary arteries bypassing the right atrium. However, this is not the most efficient configuration from a hemodynamics perspective. The goal of this study is to develop a patient-specific 4-way connector to bypass the dysfunctional right ventricle and augment the pulmonary circulation. The 4-way connector is intended to channel the blood flow from the inferior and superior vena cava directly to the right and left pulmonary arteries. By creating a connector with proper hemodynamic characteristics, one can control the jet flow interactions between the inferior and superior vena cava and streamline the flow towards the right and left pulmonary arteries. In this study the focus is on creating a system that can identify the optimal configuration for the 4-way connector for patients from 0–20 years of age. A platform is created in ANSYS that utilizes the DOE function to minimize power-loss and blood damage propensity in the connector based on junction geometries. A CFD model is created to simulate the blood flow through the connector. Then the geometry of the bypass connector is parameterized for DOE process. The selected design parameters include inlet and outlet diameters, radius at the intersection, and length of the connector pathways. The chosen range for each geometric parameter is based on the relative size of the patient’s arteries found in the literature. It was confirmed that as the patient’s age and artery size change, the optimal size and shape of the connector also changes. However, the corner radius did not decrease at the same rate as the opening diameters. This means that creating different sized connectors is not just a matter of scaling the original connector to match the desired opening diameter. However, it was found that power losses within the connector decrease and average and maximum blood traversal time through the connector increased for increasing opening radius. This information could be used to create a more specific relationship between the opening radius and the flow characteristics. So in order to create patient specific connectors, either a new more complicated trend needs to be found or an optimization program would need to be run on each patient’s specific geometry when they need a new connector.

scholarly journals Validation Study of the Accuracy of Echocardiographic Measurements of Systemic Blood Flow Volume in Newborn Infants

2013 ◽  
Vol 26 (12) ◽  
pp. 1365-1371 ◽  
Author(s):  
Benjamim Ficial ◽  
Anna E. Finnemore ◽  
David J. Cox ◽  
Kathryn M. Broadhouse ◽  
Anthony N. Price ◽  
...  
Keyword(s):  
Blood Flow ◽  
Validation Study ◽  
Newborn Infants ◽  
Flow Volume ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Blood Flow Volume
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