Haemodynamic Adaptation During Exercise in Fontan Patients at a Long-Term Follow-Up
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To assess the haemodynamic regulation at rest and during exercise in Fontan patients at a long-term follow-up.Cardiac output was measured with the dye-dilution technique. We examined 15 out of the surviving 20 patients operated upon in Göteborg between 1980 and 1991. Their mean age was 26.4 years. Four patients had to be excluded due to technical reasons.Median maximal oxygen uptake was 1.47 l/min, corresponding to 21.9 ml/kg/min. Cardiac output was lower than expected at all exercise levels, presumably due to a reduced pulmonary blood flow. The median maximal cardiac output value was 8.0 l/min. Stroke volume index was 33 ml/m (2). The subjects compensated for the reduced cardiac output with an increased arteriovenous oxygen difference. They had a normal increase in arterial blood pressure. This was achieved by an increase in total peripheral resistance.The low maximal exercise capacity was due to a reduced cardiac output and a reduced pulmonary blood flow. This was compensated for by an increased arteriovenous oxygen differenceKeywords:
Arteriovenous oxygen difference
Cardiac index
Fontan Procedure
Cardiac function was studied with Scintiview in 107 cases, 24 normal and 83 affected cases, and the following results were obtained. 1. Better data were obtained with converging collimeter than with parallel collimeter in cardiac study. (2) Red blood cells were sufficiently labeled with 99mTc using stannous chloride as reductant, and it was proven to be applicable to measurement of circulation blood volume. (3) Pulmonary circulation time and the systemic circulation time calculated from time activity curve, greater than 9.0 seconds and greater than 25 seconds, respectively, were considered abnormal prolongation. (4) Cardiac output index (cardiac output/circulation blood volume), less than 1.10 was considered decreased cardiac output. (5) Stroke volume index ((stroke volume/circulation blood volume)x 100, less than 1.70 was considered decreased stroke volume. (6) Ejection fraction, less than 60% was considered decreased left ventricular wall motion. (7) Cardiac function index (cardiac output index X ejection fraction), less than 80 was considered decreased cardiac performance.
Cardiac index
Circulation (fluid dynamics)
Blood circulation
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Stroke volume variation (SVV) has been shown to be a reliable predictor of fluid responsiveness. However, the predictive role of SVV measured by FloTrac/Vigileo system in prediction of fluid responsiveness was unproven in patients undergoing ventilation with low tidal volume.Fifty patients undergoing elective gastrointestinal surgery were randomly divided into two groups: Group C [n(1)=20, tidal volume (V(t)) = 8 ml/kg, frequency (F) = 12/min] and Group L [n(2)=30, V(t)= 6 ml/kg, F=16/min]. After anesthesia induction, 6% hydroxyethyl starch130/0.4 solution (7 ml/kg) was intravenously transfused. Besides standard haemodynamic monitoring, SVV, cardiac output, cardiac index (CI), stroke volume (SV), stroke volume index (SVI), systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI) were determined with the FloTrac/Vigileo system before and after fluid loading.After fluid loading, the MAP, CVP, SVI and CI increased significantly, whereas the SVV and SVR decreased markedly in both groups. SVI was significantly correlated to the SVV, CVP but not the HR, MAP and SVR. SVI was significantly correlated to the SVV before fluid loading (Group C: r = 0.909; Group L: r = 0.758) but not the HR, MAP, CVP and SVR before fluid loading. The largest area under the ROC curve (AUC) was found for SVV (Group C, 0.852; Group L, 0.814), and the AUC for other preloading indices in two groups ranged from 0.324 to 0.460.SVV measured by FloTrac/Vigileo system can predict fluid responsiveness in patients undergoing ventilation with low tidal volumes during gastrointestinal surgery.
Cardiac index
Intravascular volume status
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Measurements of the cardiac output utilizing the classical Fick method were carried out in 38 cardiac patients at rest and during exercise. The predicted cardiac output during exercise was calculated by the regression equation derived by Donald et al. ( Clin. Sci. 14: 37, 1955), relating cardiac output to oxygen consumption during the steady state of exercise in normal subjects (cardiac index = 3.708 + 0.00534 x O 2 consumption, ml/min m 2 ). The resting arteriovenous oxygen difference was found to correlate much better with the calculated percentage of predicted cardiac index during exercise (γ = 0.547) than did the resting cardiac index (γ = 0.304). The finding of an arteriovenous oxygen difference greater than 5.16 ml/100 cc indicated a strong probability of subnormal cardiac index during exercise relative to the oxygen consumption. Submitted on June 18, 1962
Arteriovenous oxygen difference
Cardiac index
Fick principle
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To characterize the hemodynamic factors that regulate stroke volume during upright exercise in normal man, 24 asymptomatic male volunteers were evaluated by simultaneous right heart catheterization, radionuclide angiography, and expired gas analysis during staged upright bicycle exercise to exhaustion. From rest to peak exercise, oxygen consumption increased from 0.33 to 2.55 liters/min (7.7-fold), cardiac index increased from 3.0 to 9.7 liters/min per m2 (3.2-fold), and arteriovenous oxygen difference increased from 5.8 to 14.1 vol% (2.5-fold). The increase in cardiac index resulted from an increase in heart rate from 73 to 167 beats/min (2.5-fold), and an increase in left ventricular stroke volume index from 41 to 58 ml/m2 (1.4-fold). During low levels of exercise, there was a linear increase in cardiac index due to an increase in both heart rate and stroke volume index; stroke volume index increased as a result of an increase in left ventricular filling pressure and end-diastolic volume index and, to a much smaller extent, a decrease in end-systolic volume index. During high levels of exercise, further increases in cardiac index resulted entirely from an increase in heart rate, since stroke volume index increased no further. Left ventricular end-diastolic volume index decreased despite a linear increase in pulmonary artery wedge pressure; stroke volume index was maintained by a further decrease in end-systolic volume index. The degree to which stroke volume index increased during exercise in individuals correlated with the change in end-diastolic volume index (r = 0.66) but not with the change in end-systolic volume index (r = 0.07). Thus, the mechanism by which left ventricular stroke volume increases during upright exercise in man is dependent upon the changing relationship between heart rate, left ventricular filling, and left ventricular contractility. At low levels of exertion, an increase in left ventricular filling pressure and end-diastolic volume are important determinants of the stroke volume response through the Starling mechanism. At high levels of exertion, the exercise tachycardia is accompanied by a decrease in end-diastolic volume despite a progressive increase in filling pressure, so that stroke volume must be maintained by a decrease in end-systolic volume.
Cardiac index
Pulmonary wedge pressure
End-systolic volume
Arteriovenous oxygen difference
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Objective To evaluate the application of the FloTrac/VigileoTM system to the patients with severe pregnancy- induced hypertension undergoing cesarean section. Methods Twenty-,seven patients with severe pregnancy-induced hypertension scheduled for cesarean section were selected. Mean arterial pressure （MAP）, heart rate （HR）, cardiac output （CO）, cardiac index （CI）, stroke volume（SV）, stroke volume variation（SVV）, stroke volume index（SVI） were measured and recorded at 6 selected time points： preoperation, 5 min after anesthesia, the start of the operation, expulsion, cleaning the peritoneal cavity, the end of operation. Results There were no significant differences in the hemodynamic indexes between preoperation and other time points.. In this study, the CO of patient varied in the range of 3.5 L/min-8.0 L/min, and CI in the range of 2 L·min-1·m-2-4 L·min-1·m-2. Conclusion The FloTrac/VigileoTM system can show the changes of cardiac function in time during operation, which is a safe, reliable monitor for hemodynamic monitoring during cesarean section of patients with severe pregnancy-induced hypertension.
Key words:
Cardiac output; Mornitor; Anesthesia management
Cardiac index
Mean arterial pressure
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To characterize the hemodynamic factors that regulate stroke volume during upright exercise in normal man, 24 asymptomatic male volunteers were evaluated by simultaneous right heart catheterization, radionuclide angiography, and expired gas analysis during staged upright bicycle exercise to exhaustion. From rest to peak exercise, oxygen consumption increased from 0.33 to 2.55 liters/min (7.7-fold), cardiac index increased from 3.0 to 9.7 liters/min per m2 (3.2-fold), and arteriovenous oxygen difference increased from 5.8 to 14.1 vol% (2.5-fold). The increase in cardiac index resulted from an increase in heart rate from 73 to 167 beats/min (2.5-fold), and an increase in left ventricular stroke volume index from 41 to 58 ml/m2 (1.4-fold). During low levels of exercise, there was a linear increase in cardiac index due to an increase in both heart rate and stroke volume index; stroke volume index increased as a result of an increase in left ventricular filling pressure and end-diastolic volume index and, to a...
Cardiac index
Arteriovenous oxygen difference
Radionuclide angiography
Stroke
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Hemodynamic indices were determined in 13 anesthetized dogs. In 7 of them,iv injection of endotoxin(E coli 12*10(10)/mL/kg) followed by iv infusion of saline(0.05/ mL/kg/min) increased the vascular resistance, and decreased the mean arterial pressure, the stroke volume, cardiac output and cardiac index. In the other 6 dogs, iv jinfusion of higenamine (dl-demethylcoclaurine) 1 microg/kg/min after iv endotoxin caused no significant changes in blood pressure, decreased the vascular resistance and icreased the stroke volume, cardiac output and cardiac index as compared with those of the control dogs. These results suggest that higenamine improves the circulation of the endotoxin shock dogs.
Cardiac index
Mean arterial pressure
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Oxygen uptake and cardiac output at rest and during exercise were studied in 19 men operated on for coarctation of the aorta during childhood. Their aerobic capacity and their maximal values for cardiac output, stroke volume and arteriovenous oxygen difference were normal. No differences were found regarding these variables between hypertensive and normotensive subjects. Thus, there was no sign of failure of the left ventricle even in patients with high blood pressure during exercise. Whether the normal arteriovenous oxygen difference indicates a normal distribution of the cardiac output cannot be settled from the present data.
Arteriovenous oxygen difference
Rest (music)
Aerobic Exercise
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We prospectively studied 18 patients with septic shock prior to and during volume infusion in order to evaluate their hemodynamic response to fluid repletion. Fluid challenge increased left heart filling pressure from 7.7 +/- 0.5 to 15.4 +/- 0.6 mm Hg (P less than .01). The increases in left ventricular filling were associated with significant increases in stroke volume index from 25.4 +/- 2.5 to 35.7 +/- 2.5 ml/min/M2 and cardiac index from 2.49 +/- 0.19 to 3.32 +/- 0.16 L/min/M2. However, at the end of fluid challenge, the patients exhibited depressed left ventricular performance as evidenced by a left ventricular stroke work index of 29.5 +/- 2.6 g X m/M2. Over the next 24 hours of maintenance fluid infusion, the left ventricular stroke work index increased to 36.8 +/- 4.2 g X m/M2 (not significant). These data suggest that volume infusion restores ventricular filling in patients with sepsis. Although fluid repletion increases stroke and cardiac output, depressed left ventricular performance appears to be an early finding in septic shock.
Cardiac index
Stroke
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Arteriovenous oxygen difference
End-diastolic volume
Stroke
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