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(Circulation. 1997;96:3934-3942.)
© 1997 American Heart Association, Inc.

Articles

Cardiopulmonary Interactions After Fontan Operations

Augmentation of Cardiac Output Using Negative Pressure Ventilation

Lara S. Shekerdemian, MRCP; Andrew Bush, FRCP; Darryl F. Shore, FRCS; Christopher Lincoln, FRCS; ; Andrew N. Redington, FRCP

From the Departments of Paediatrics (L.S.S., A.B., A.N.R.) and Surgery (D.F.S., C.L.), Royal Brompton Hospital, London SW3 6NP, UK.

Correspondence to Prof A. Redington, Professor of Congenital Heart Disease, Royal Brompton Hospital, Sydney St, London SW3 6NP, UK. E-mail reding{at}ibm.net

Background The low-output state is the chief cause of morbidity and mortality after Fontan operations. An alternative hemodynamic tool would be a welcome addition for these patients, who are typically resistant to conventional therapeutic measures.

Methods and Results The hemodynamic effects of conversion from conventional intermittent positive pressure ventilation (IPPV) to cuirass negative pressure ventilation (NPV) was investigated in nine acute postoperative Fontan patients on the pediatric intensive care unit and nine anesthetized patients undergoing cardiac catheterization in the convalescent phase after Fontan operations. Pulmonary blood flow was measured using the direct Fick method during IPPV and after a brief period of NPV. In one subgroup of patients, pulmonary blood flow was measured again after reinstitution of IPPV, and in a second subgroup, pulmonary blood flow was measured after an extended period of NPV. A brief period of NPV increased pulmonary blood flow from 2.4 to 3.5 L · min^-1 · /m^-2, with a mean increase of 42%. Pulmonary blood flow continued to improve, with a total increase of 54% after an extended period of NPV. Values fell toward baseline after reinstitution of IPPV. Heart rate was unchanged during NPV, and the improvement in pulmonary blood flow was achieved by an increase in stroke volume from 25 mL/m² to 37 mL/m.²

Conclusions Through improvement of the stroke volume alone, NPV brought about a marked increase in the pulmonary blood flow and, hence, cardiac output of Fontan patients. An improvement in cardiac output of this order, and by this mechanism, is currently unmatched by any therapeutic alternatives.

Key Words: Fontan procedure • cardiac output • ventilation

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