Intraoperative evaluation of pulmonary artery flow during the Fontan procedure by transesophageal Doppler echocardiography

Citation
S. Kawahito et al., Intraoperative evaluation of pulmonary artery flow during the Fontan procedure by transesophageal Doppler echocardiography, ANESTH ANAL, 91(6), 2000, pp. 1375-1380
Citations number
20
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
ANESTHESIA AND ANALGESIA
ISSN journal
0003-2999 → ACNP
Volume
91
Issue
6
Year of publication
2000
Pages
1375 - 1380
Database
ISI
SICI code
0003-2999(200012)91:6<1375:IEOPAF>2.0.ZU;2-4
Abstract
After the Fontan procedure, pulmonary artery (PA) flow is maintained withou t right ventricular pump function. We evaluated intraoperative PA flow velo city patterns using transesophageal Doppler echocardiography (TEE) immediat ely after cardiopulmonary bypass (CPB) in patients during Fontan or hemi-Fo ntan procedures. We studied 10 patients with single-ventricle physiology (a ge range, 5 mo to 3 yr 1 mo). Anesthesia was induced and maintained with fe ntanyl. After induction of anesthesia, a pediatric TEE probe was inserted i nto the esophagus. All patients had surgical repair involving direct anasto mosis of the right atrium to the PA. Immediately after completion of CPB, a dequacy of the atriopulmonary anastomosis was assessed and PA flow velocity was recorded. In all patients, the atriopulmonary anastomosis was dearly d efined using a single-plane TEE probe, and PA flow recording was completed successfully. Intraoperative PA flow velocities showed two distinct pattern s. Biphasic forward flows with peak velocities during systole and diastole were observed in six patients. The remaining four patients showed forward f lows with flow reversals. The four patients demonstrating flow reversals sh owed significantly reduced fractional shortening (26.5 +/- 2.1% vs 35.5 +/- 6.3%) and larger pressure gradient between the right atrium and left atriu m (10.8 +/- 1.3 mm Hg vs 8.0 +/- 0.9 mm Hg) when compared to those without reverse flow. Two patients with reverse flow required reoperation because o f hypotension. Because PA flow is influenced by pulmonary vascular resistan ce and left ventricular function, TEE assessed intraoperative PA flow shoul d be further evaluated as a useful predictor of surgical outcome after a Fo ntan procedure.