Acute adaptation to volume unloading of the functional single ventricle in children undergoing bidirectional Glenn anastomosis

Catherine Ikemba, Matthew Lemler, Lonnie Roi, Jason Su, Louis Bezold, Anthony Chang, E. Dean McKenzie, Charles Fraser, Dean Andropoulus, Benjamin W. Eidem

Research output: Contribution to journalArticle

Abstract

Objective. Volume unloading of the functional single ventricle after a bidirectional Glenn anastomosis (BDG) prior to 1 year of age leads to improved global ventricular function as measured by the myocardial performance index (MPI), a Doppler-derived measurement of combined systolic and diastolic ventricular function. Systolic function remains unchanged after BDG according to previous studies; however, acute changes in global and diastolic function have not been previously investigated in this cohort. Our objective was to assess the short-term effects of the BDG on global ventricular function in patients with a functional single ventricle. Design. Echocardiograms to obtain MPI, isovolumic contraction time, and isovolumic relaxation time were performed at four time periods: in the operating room, in the operating room prior to BDG, shortly after separation from cardiopulmonary bypass, less than 24 hours postoperatively, and either prior to hospital discharge or at the first clinic follow-up visit. Results. Twenty-six patients were enrolled. There was significant ventricular dysfunction noted shortly after separation from cardiopulmonary bypass, median MPI 0.63 (0.39-0.81), that persisted in the short term postoperatively median MPI 0.50 (0.40-0.63). Isovolumic contraction time did not change, however, isovolumic relaxation time was significantly prolonged following BDG. Conclusion. In the postoperative patient after BDG, systolic function is preserved; however, there is evidence of diastolic and global ventricular dysfunction, at least in the short term.

Original languageEnglish (US)
Pages (from-to)76-80
Number of pages5
JournalCongenital Heart Disease
Volume4
Issue number2
DOIs
StatePublished - Mar 2009

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Ventricular Function
Ventricular Dysfunction
Operating Rooms
Cardiopulmonary Bypass

Keywords

  • Bidirectional glenn
  • Myocardial performance index
  • Postoperative ventricular function
  • Single ventricle

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging

Cite this

Acute adaptation to volume unloading of the functional single ventricle in children undergoing bidirectional Glenn anastomosis. / Ikemba, Catherine; Lemler, Matthew; Roi, Lonnie; Su, Jason; Bezold, Louis; Chang, Anthony; McKenzie, E. Dean; Fraser, Charles; Andropoulus, Dean; Eidem, Benjamin W.

In: Congenital Heart Disease, Vol. 4, No. 2, 03.2009, p. 76-80.

Research output: Contribution to journalArticle

Ikemba, Catherine ; Lemler, Matthew ; Roi, Lonnie ; Su, Jason ; Bezold, Louis ; Chang, Anthony ; McKenzie, E. Dean ; Fraser, Charles ; Andropoulus, Dean ; Eidem, Benjamin W. / Acute adaptation to volume unloading of the functional single ventricle in children undergoing bidirectional Glenn anastomosis. In: Congenital Heart Disease. 2009 ; Vol. 4, No. 2. pp. 76-80.
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AU - Ikemba, Catherine

AU - Lemler, Matthew

AU - Roi, Lonnie

AU - Su, Jason

AU - Bezold, Louis

AU - Chang, Anthony

AU - McKenzie, E. Dean

AU - Fraser, Charles

AU - Andropoulus, Dean

AU - Eidem, Benjamin W.

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N2 - Objective. Volume unloading of the functional single ventricle after a bidirectional Glenn anastomosis (BDG) prior to 1 year of age leads to improved global ventricular function as measured by the myocardial performance index (MPI), a Doppler-derived measurement of combined systolic and diastolic ventricular function. Systolic function remains unchanged after BDG according to previous studies; however, acute changes in global and diastolic function have not been previously investigated in this cohort. Our objective was to assess the short-term effects of the BDG on global ventricular function in patients with a functional single ventricle. Design. Echocardiograms to obtain MPI, isovolumic contraction time, and isovolumic relaxation time were performed at four time periods: in the operating room, in the operating room prior to BDG, shortly after separation from cardiopulmonary bypass, less than 24 hours postoperatively, and either prior to hospital discharge or at the first clinic follow-up visit. Results. Twenty-six patients were enrolled. There was significant ventricular dysfunction noted shortly after separation from cardiopulmonary bypass, median MPI 0.63 (0.39-0.81), that persisted in the short term postoperatively median MPI 0.50 (0.40-0.63). Isovolumic contraction time did not change, however, isovolumic relaxation time was significantly prolonged following BDG. Conclusion. In the postoperative patient after BDG, systolic function is preserved; however, there is evidence of diastolic and global ventricular dysfunction, at least in the short term.

AB - Objective. Volume unloading of the functional single ventricle after a bidirectional Glenn anastomosis (BDG) prior to 1 year of age leads to improved global ventricular function as measured by the myocardial performance index (MPI), a Doppler-derived measurement of combined systolic and diastolic ventricular function. Systolic function remains unchanged after BDG according to previous studies; however, acute changes in global and diastolic function have not been previously investigated in this cohort. Our objective was to assess the short-term effects of the BDG on global ventricular function in patients with a functional single ventricle. Design. Echocardiograms to obtain MPI, isovolumic contraction time, and isovolumic relaxation time were performed at four time periods: in the operating room, in the operating room prior to BDG, shortly after separation from cardiopulmonary bypass, less than 24 hours postoperatively, and either prior to hospital discharge or at the first clinic follow-up visit. Results. Twenty-six patients were enrolled. There was significant ventricular dysfunction noted shortly after separation from cardiopulmonary bypass, median MPI 0.63 (0.39-0.81), that persisted in the short term postoperatively median MPI 0.50 (0.40-0.63). Isovolumic contraction time did not change, however, isovolumic relaxation time was significantly prolonged following BDG. Conclusion. In the postoperative patient after BDG, systolic function is preserved; however, there is evidence of diastolic and global ventricular dysfunction, at least in the short term.

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