Cerebrovascular Blood Flow Dynamic Changes in Fetuses with Congenital Heart Disease

2009 ◽  
Vol 25 (1) ◽  
pp. 167-172 ◽  
Author(s):  
Lv Guorong ◽  
Li Shaohui ◽  
Jin Peng ◽  
Lin Huitong ◽  
Li Boyi ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Congenital Heart ◽  
Flow Dynamic ◽  
Dynamic Changes ◽  
Blood Flow Dynamic

Dilatable Pulmonary Artery Banding Palliation in Congenital Heart Disease

2021 ◽  
Vol 12 (2) ◽  
pp. 213-219
Author(s):  
R. Allen Ligon ◽  
Larry A. Latson ◽  
Mark M. Ruzmetov ◽  
Kak-Chen Chan ◽  
Immanuel I. Turner ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Pulmonary Artery ◽  
Pulmonary Blood Flow ◽  
Congenital Heart ◽  
Balloon Dilation ◽  
Retrospective Chart Review ◽  
Pulmonary Artery Banding ◽  
Surgical Removal

Background: Surgical pulmonary artery banding (PAB) has been limited in practice because of later requirement for surgical removal or adjustment. The aim of this study is to describe our experience creating a dilatable PAB via transcatheter balloon dilation (TCBD) in congenital heart disease (CHD) patients. Methods: Retrospective chart review of adjustable PAB—outline anatomical variants palliated and patient outcomes. Results: Sixteen patients underwent dilatable PAB—median age 52 days (range 4-215) and weight 3.12 kg (1.65-5.8). Seven (44%) of the patients were premature, 11 (69%) had ventricular septal defect(s) with pulmonary over-circulation, four (25%) atrioventricular septal defects, and four (25%) single ventricle physiology. Subsequent to the index procedure: five patients have undergone intracardiac complete repair, six patients remain well palliated with no additional intervention, and four single ventricles await their next palliation. One patient died from necrotizing enterocolitis (unrelated to PAB) and one patient required a pericardiocentesis postoperatively. Five patients underwent TCBD of the PAB without complication—Two had one TCBD, two had two TCBD, and another had three TCBD. The median change in saturation was 14% (complete range 6-22) and PAB diameter 1.7 mm (complete range 1.1-5.2). Median time from PAB to most recent outpatient follow-up was 868 days (interquartile range 190-1,079). Conclusions: Our institution has standardized a PAB technique that allows for transcatheter incremental increases in pulmonary blood flow over time. This methodology has proven safe and effective enough to supplant other institutional techniques of limiting pulmonary blood flow in most patients—allowing for interval growth or even serving as the definitive palliation.

Effect of Variation in Arterial Carbon Dioxide Levels on Cerebral-Somatic Oxygenation in Children with Cyanotic Congenital Heart Disease

2018 ◽  
pp. 1-6
Keyword(s):  
Carbon Dioxide ◽  
Congenital Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Infrared Spectroscopy ◽  
Congenital Heart ◽  
Near Infrared ◽  
Cyanotic Congenital Heart Disease ◽  
Anesthesia Induction ◽  
Arterial Blood

Background: Hypocapnia is suggested in decreasing pulmonary vascular resistance in cyanotic congenital heart disease patients undergoing definitive repair. But its effects on cerebral and renal circulation are unclear. Hence the effect of changes in arterial blood carbon dioxide tensions (PaCo2 ) on cerebral (ScO2 %) and renal (SsO2 %) oxygenation indices using Near Infrared spectroscopy (NIRS) is examined. Methods: We did a prospective observational study in sixty-eight children who underwent elective cardiac surgery for various cyanotic congenital heart diseases. PaCo2 , ScO2 % and SsO2 % were obtained before induction of anesthesia, after anesthesia induction at normocapnic or mild hypercapnic ventilation (EtCo2 =40 mmHg) and again at hypocapnic ventilation (EtCo2 =30 mmHg). Regression analysis was done between PaCo2 and NIRS-C/ScO2 % and PaCo2 and NIRS-R/SsO2 % at both EtCo2 40 and 30 mmHg. Repeated measure analysis performed to evaluate the significance of change in NIRS-C and NIRS-R from pre-anesthesia induction to when EtCo2 was 40 and then 30 mmHg post anesthesia induction. Results: With decrease in EtCo2 , PaCo2 (p=0.0001), NIRS-C (p=0.0001) and NIRS-R (p=0.0001) decreased significantly. At EtCo2 of 40 and 30 mmHg, PaCo2 had significant positive correlation with NIRS-C (R2 =0.77, p=0.0001 and R2 =0.92, p=0.0001 respectively) and had insignificant correlation with NIRS-R (R2 =0.03, p=0.12 and R2 =0.008, p=0.46 respectively). Significant changes in NIRS-C {p=0.0001} and NIRS-R {p=0.0001} occurred from pre-induction to when EtCo2 was 40 and then to 30 mmHg. Conclusion: A decrease in NIRS-C and NIRS-R is probably from decreased cerebral and splanchnic blood flow during hypocapnic ventilation, leading to demand supply mismatch. Hypocapnic ventilation in cyanotic children has potential to cause cerebral hypoxia. Abbreviations: CCHD: Cyanotic Congenital Heart Disease; QP: Pulmonary blood flow; Do2 : Oxygen delivery; SpO2 : peripheral pulse oximetry; NIRS: Near Infrared Spectroscopy; NIRS-C/ScO2 %: Regional Cerebral Oxygen saturation; NIRS-R/SsO2 %: Regional Somatic/renal Oxygen saturation; HCT: Hematocrit; ECG: Electrocardiography; CPB: cardiopulmonary bypass; TOF: Tetralogy of fallot; BDG: Bidirectional Glenn Shunt; BT shunt: Blalock Taussig shunt; DORV: Double outlet right ventricle; FiO2 : Inspired oxygen concentration; ABG: Arterial blood gas; PaO2 : Arterial oxygen partial pressure; PaCo2 : Arterial carbon dioxide partial pressure; HR: Heart rate; MAP: Mean Arterial Pressure; CVP: Central Venous Pressure

Prolonged Prostaglandin E1 Infusion in an Infant With Cyanotic Congenital Heart Disease

PEDIATRICS ◽  
1978 ◽  
Vol 61 (4) ◽  
pp. 534-536
Author(s):  
Alan B. Lewis ◽  
Paul R. Lurie
Keyword(s):  
Congenital Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pulmonary Blood Flow ◽  
Congenital Heart ◽  
Prostaglandin E1 ◽  
Ductus Arteriosus ◽  
Cyanotic Congenital Heart Disease

A small-for-gestational-age premature infant with severe tetralogy of Fallot was treated with prostaglandin E1 to dialate the ductus arteriosus and increase pulmonary blood flow. The infusion was continued for 29 days without complication at which time surgery was performed.

Ductal stenting in congenital heart disease with duct dependent pulmonary blood flow

2020 ◽  
Vol 73 (10) ◽  
pp. 859-861
Author(s):  
Laura Marfil-Godoy ◽  
Gerard Martí-Aguasca ◽  
Queralt Ferrer-Menduiña ◽  
Gemma Giralt-García ◽  
Pedro Betrián-Blasco
Keyword(s):  
Congenital Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Pulmonary Blood Flow ◽  
Congenital Heart

4D flow magnetic resonance imaging: role in pediatric congenital heart disease

2017 ◽  
Vol 26 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Claire M Lawley ◽  
Kathryn M Broadhouse ◽  
Fraser M Callaghan ◽  
David S Winlaw ◽  
Gemma A Figtree ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Congenital Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Magnetic Resonance ◽  
Congenital Heart ◽  
Pediatric Population ◽  
Anatomical Location ◽  
Resonance Imaging ◽  
Dimensional Flow

Imaging-based evaluation of cardiac structure and function remains paramount in the diagnosis and monitoring of congenital heart disease in childhood. Accurate measurements of intra- and extracardiac hemodynamics are required to inform decision making, allowing planned timing of interventions prior to deterioration of cardiac function. Four-dimensional flow magnetic resonance imaging is a nonionizing noninvasive technology that allows accurate and reproducible delineation of blood flow at any anatomical location within the imaging volume of interest, and also permits derivation of physiological parameters such as kinetic energy and wall shear stress. Four-dimensional flow is the focus of a great deal of attention in adult medicine, however, the translation of this imaging technique into the pediatric population has been limited to date. A more broad-scaled application of 4-dimensional flow in pediatric congenital heart disease stands to increase our fundamental understanding of the cause and significance of abnormal blood flow patterns, may improve risk stratification, and inform the design and use of surgical and percutaneous correction techniques. This paper seeks to outline the application of 4-dimensional flow in the assessment and management of the pediatric population affected by congenital heart disease.

Computational fluid dynamics: a primer for congenital heart disease clinicians

2020 ◽  
Vol 28 (8) ◽  
pp. 520-532
Author(s):  
Rabin Gerrah ◽  
Stephen J Haller
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Congenital Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Congenital Heart ◽  
The Finite Element Method ◽  
Blood Flow Dynamics ◽  
Clinical Questions ◽  
Volume Method

Computational fluid dynamics has become an important tool for studying blood flow dynamics. As an in-silico collection of methods, computational fluid dynamics is noninvasive and provides numerical values for the most important parameters of blood flow, such as velocity and pressure that are crucial in hemodynamic studies. In this primer, we briefly explain the basic theory and workflow of the two most commonly applied computational fluid dynamics techniques used in the congenital heart disease literature: the finite element method and the finite volume method. We define important terminology and include specific examples of how using these methods can answer important clinical questions in congenital cardiac surgery planning and perioperative patient management.

P1796Adults with congenital heart disease have impaired calf muscle oxygenation compared to control subjects

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Sandberg ◽  
A G Crenshaw ◽  
G H Elcadi ◽  
C Christersson ◽  
J Hlebowicz ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Exercise Capacity ◽  
Congenital Heart ◽  
Near Infrared ◽  
Venous Occlusion ◽  
Calf Muscle ◽  
Muscle Oxygenation ◽  
Peripheral Muscle

Abstract Background Peripheral muscle factors are presumed to be important contributors to the reduced exercise capacity in congenital heart disease (CHD), but the mechanisms are poorly understood. Purpose To investigate if muscle oxygenation in the calf muscle is impaired in adults with complex CHD in comparison to controls. Method Seventy-four adults with complex CHD (35.6±14.3 years, females n=22) were recruited from centers specialized in adult CHD. Seventy-four age and gender matched subjects were recruited as controls. Muscle oxygenation was successfully determined using near-infrared spectroscopy on the medial portion of m. gastrocnemiusin 63 patients and 67 controls. Measurements were made at rest, during venous occlusion to estimate blood flow (BF – indicated by the slope increase of total haemoglobin, HbT), at the start of isotonic unilateral heel-lifts to exhaustion, and immediately after exercise. Results In comparison to controls, patients had a lower muscle saturation (StO2) at rest, albeit not statistically significant, (66±17% vs. 60±19%, p=0.07), and a lower BF (0.38±0.21 vs. 0.31±0.21 HbTx3.5sec–1, p=0.07). For exercise, compared to the controls, patients had a slower desaturation rate at exercise onset (−11.7±5.8% vs. −7.7±4.3%. StO2x3.5sec–1, p<0.001), and both a slower resaturation rate (6.1±3.8% vs. 3.9±3.7% StO2x3.5sec–1, p=0.002) and a slower half recovery time (16.8±11.1 vs. 28.6±21.2 sec, p<0.001) post exercise. Conclusion The lower muscle oxygenation and blood flow at rest, and the slower oxygenation kinetics during exercise may give insight to the mechanism for the reduced exercise capacity commonly found in adults with complex CHD. This finding may also provide implications for design of rehabilitation programs for these patients.

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