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Are dynamic measurements of central venous pressure in Fontan circulation during exercise or volume loading superior to resting measurements?

Published online by Cambridge University Press:  20 November 2023

Alyssia Venna Open the ORCID record for Alyssia Venna [Opens in a new window] ,
Shriprasad Deshpande Open the ORCID record for Shriprasad Deshpande [Opens in a new window] ,
Tacy Downing Open the ORCID record for Tacy Downing [Opens in a new window] ,
Anitha John  and
Yves d’Udekem
Alyssia Venna
Affiliation:
Division of Cardiac Surgery, Children’s National Hospital, Washington, DC, USA
Shriprasad Deshpande
Affiliation:
Division of Cardiology, Children’s National Health System, Washington, DC, USA
Tacy Downing
Affiliation:
Division of Cardiology, Children’s National Health System, Washington, DC, USA
Anitha John
Affiliation:
Division of Cardiology, Children’s National Health System, Washington, DC, USA
Yves d’Udekem*
Affiliation:
Division of Cardiac Surgery, Children’s National Hospital, Washington, DC, USA
*
Corresponding author: Y. d’Udekem; Email: yves.dudekem@childrensnational.org
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Abstract

Background:

The main objective measure to assess the health of the Fontan circulation is the pressure measurement of the superior vena cava or pulmonary arteries. We reviewed the literature for benefits of measuring resting pressure in the Fontan circuit and explored whether dynamic measurement by volume loading or exercise has the potential to refine this diagnostic tool.

Methods:

PubMed was searched for articles showing a relationship between resting post-operative central venous pressure or pulmonary artery pressure and Fontan failure. Relationships between post-operative central venous pressure or pulmonary artery pressure and volume loading changes, such as during exercise or volume loading during cardiac catheterization, were also queried.

Results:

A total of 44 articles mentioned relationships between resting central venous pressure or pulmonary artery pressure and Fontan failure. Only 26 included an analysis between the variables and only seven of those articles found pressure to be predictive of Fontan failure. Ten articles examined the relationship between exercise or volume loading and outcomes and demonstrated a large individual variation of pressures under these dynamic conditions.

Conclusions:

Based on current literature, there is not a lot of strong evidence to show that elevated resting central venous pressure or pulmonary artery pressure is predictive of Fontan failure. Some individuals experience dramatic increases in central venous pressure or pulmonary artery pressure under increased loading conditions with exercise or bolus fluid infusion, while others experience increases closer to that of a healthy control population. Further studies are needed to examine whether more dynamic and continuous monitoring of systemic venous pressures might better predict outcomes in patients with Fontan circulation.

Keywords

Systemic venous pressureFontan circulationFontan failureexercisevolume loading
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 12
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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