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Non-invasive cardiac output monitoring during catheter interventions in patients with cavopulmonary circulations

Published online by Cambridge University Press:  17 May 2013

Patrick Michael Emmet Noonan ,
Sangeetha Viswanathan ,
Amy Chambers  and
Oliver Stumper
Patrick Michael Emmet Noonan
Affiliation:
The Heart Unit, Birmingham Children's Hospital, Cardiology, Birmingham, United Kingdom
Sangeetha Viswanathan
Affiliation:
The Heart Unit, Birmingham Children's Hospital, Cardiology, Birmingham, United Kingdom
Amy Chambers
Affiliation:
The Heart Unit, Birmingham Children's Hospital, Cardiology, Birmingham, United Kingdom
Oliver Stumper*
Affiliation:
The Heart Unit, Birmingham Children's Hospital, Cardiology, Birmingham, United Kingdom
*
Correspondence to: Dr O. Stumper, MD, PhD, Department of Cardiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom. Tel: 0121 333 9999; Fax: 0121 333 9441; E-mail: oliver.stumper@bch.nhs.uk
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Abstract

Introduction: Functionally univentricular hearts palliated with superior or total cavopulmonary connection result in circulations in series. The absence of a pre-pulmonary pump means that cardiac output is more difficult to adjust and control. Continuous monitoring of cardiac output is crucial during cardiac catheter interventions and can provide new insights into the complex physiology of these lesions. Materials and methods: The Icon® cardiac output monitor was used to study the changes in cardiac output during catheter interventions in 15 patients (median age: 6.1 years, range: 4.8–15.3 years; median weight: 18.5 kg, range: 15–63 kg) with cavopulmonary circulations. A total of 19 interventions were undertaken in these patients and the observed changes in cardiac output were recorded and analysed. Results: Cardiac output was increased with creation of stent fenestrations after total cavopulmonary connection (median increase of 22.2, range: 6.7%–28.6%) and also with drainage of significant pleural effusions (16.7% increase). Cardiac output was decreased with complete or partial occlusion of fenestrations (median decrease of 10.6, range: 7.1%–13.4%). There was a consistent increase in cardiac output with stenting of obstructive left pulmonary artery lesions (median increase of 7.7, range: 5%–14.3%, p = 0.007). Conclusions: Icon® provides a novel technique for the continuous, non-invasive monitoring of cardiac output. It provides a further adjunct for monitoring of physiologically complex patients during catheter interventions. These results are consistent with previously reported series involving manipulation of fenestrations. This is the first report identifying an increase in cardiac output with stenting of obstructive pulmonary arterial lesions.

Keywords

Cardiac outputcatheterisationcavopulmonary connections
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 3 , June 2014 , pp. 417 - 421
Copyright
Copyright © Cambridge University Press 2013 

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References

1. Gewillig, M. The Fontan circulation. Heart 2005; 91: 839–846.Google Scholar
2. Gewillig, M, Brown, SC, Eyskens, B, et al. The Fontan circulation: who controls cardiac output? Interact Cardiovasc Thorac Surg 2010; 10: 428–433.CrossRefGoogle ScholarPubMed
3. Wilkinson, J. Congenital heart disease: haemodynamic calculations in the catheter laboratory. Heart 2001; 85: 113–120.Google Scholar
4. Swan, H, Ganz, W, Forrester, J, Marcus, H, Diamond, G, Chonette, D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 1970; 283: 447–451.Google Scholar
5. Rudolph, A. Congenital diseases of the heart: clinical-physiological considerations. Futura Publishing Company, New York, 2001.Google Scholar
6. Gondos, T, Marjanek, Z, Kisvarga, Z, Halasz, G. Precision of transpulmonary thermodilution: how many measurements are necessary? Eur J Anaes 2009; 26: 508–512.Google Scholar
7. Kadota, L. Reproducibility of thermodilution cardiac output measurements. Heart Lung 1986; 15: 618–622.Google Scholar
8. Zoremba, N, Bickenbach, J, Krauss, B, Rossaint, R, Kuhlen, R, Schalte, G. Comparison of electrical velocimetry and thermodilution techniques for the measurement of cardiac output. Acta Anaesthesiol Scand 2007; 51: 1314–1319.CrossRefGoogle ScholarPubMed
9. Schmidt, C, Theilmeier, G, Van Aken, H, et al. Comparison of electrical velocimetry and transoesophageal Doppler echocardiography for measuring stroke volume and cardiac output. Br J Anaesth 2005; 95: 603–610.CrossRefGoogle ScholarPubMed
10. Norozi, K, Beck, C, Osthaus, WA, Wille, I, Wessel, A, Bertram, H. Electrical velocimetry for measuring cardiac output in children with congenital heart disease. Br J Anaesth 2008; 100: 88–94.CrossRefGoogle ScholarPubMed
11. Anderson, B, Bhole, V, Desai, T, Mehta, C, Stumper, O. Novel technique to reduce the size of a Fontan diabolo stent fenestration. Cathet Cardiovasc Int 2010; 76: 860–864.CrossRefGoogle ScholarPubMed
12. Stumper, O, Gewillig, M, Vettukattil, J, et al. Modified technique of stent fenestration of the atrial septum. Heart 2003; 89: 1227–1230.CrossRefGoogle ScholarPubMed
13. Hijazi, Z, Fahey, J, Kleinman, C, Kopf, G, Hellenbrand, W. Hemodynamic evaluation before and after closure of fenestrated Fontan: an acute study of changes in oxygen delivery. Circulation 1992; 86: 196–202.CrossRefGoogle Scholar
14. Schmidlin, D, Bettex, D, Bernard, E, et al. Transoesophageal echocardiography in cardiac and vascular surgery: implications and observer variability. Br J Anaesth 2001; 86: 497–505.Google Scholar