Characterization of Flow Efficiency, Pulsatility, and Respiratory Variability in Different Types of Fontan Circuits Using Quantitative Parameters

PURPOSE: Details on the hemodynamic differences among Fontan operations remain unclear according to respiratory and cardiac cycles. This study was undertaken to investigate hemodynamic characteristics in different types of Fontan circulation by quantification of blood flow with the combined influence of cardiac and respiratory cycles. MATERIALS AND METHODS: Thirty-five patients [10 atriopulmonary connections (APC), 13 lateral tunnels (LT), and 12 extracardiac conduits (ECC)] were evaluated, and parameters were measured in the superior vena cava, inferior vena cava (IVC), hepatic vein (HV), baffles, conduits, and left and right pulmonary artery. Pulsatility index (PIx), respiratory variability index (RVI), net antegrade flow integral (NAFI), and inspiratory/expiratory blood flow (IQ/EQ) were measured by intravascular Doppler echocardiography. RESULTS: The PIx between APC and total cavopulmonary connection (TCPC; LT and ECC) showed significant differences at all interrogation points regardless of respiratory cycles. The PIxs of HVs and IVCs in APC significantly increased, compared with that in LT and ECC, and the RVI between APC and TCPC showed significant differences at all interrogation points (p < 0.05). The NAFI and IQ/EQ between APC and TCPC showed significant differences at some interrogation points (p < 0.05). CONCLUSION: Patients with different types of Fontan circulation show different hemodynamic characteristics in various areas of the Fontan tract, which may lead to different risks causing long-term complications. We believe the novel parameters developed in this study may be used to determine flow characteristics and may serve as a clinical basis of management in patients after Fontan operations.

Comparação dos Efeitos Hemodinâmicos e Respiratórios no Uso dos Sistemas de Aspiração Traqueal Aberto e Fechado / Comparison of Hemodynamic and Respiratory Effects in the Use of Open and Closed Tracheal Suctioning Systems

Objetivo do estudo foi comparar o sistema fechado de aspiração (SFA) com o sistema aberto de aspiração (SAA) e, para cada sistema, comparar variáveis hemodinâmicas e respiratórias para cada um dos momentos. Incluídos pacientes adultos, em ventilação mecânica em pós-operatório eletivo. Variáveis registradas pré-coleta, 15 e 30 minutos após a adaptação do SFA, imediatamente, após a oxigenação pós-aspiração com SFA, nos minutos 6, 16, 31 e 61 após aspiração com o SFA. O mesmo processo foi repetido para o SAA. Foram incluídos quarenta pacientes. Quando comparado o momento imediato a pós-oxigenação com o momento 6 minutos após a aspiração foi encontrado aumento da frequência cardíaca (FC) (p = 0,04), diminuição (p= 0,034) com o momento 31 minutos e diminuição (p= 0,032) com o momento 61 minutos. Observou-se que a FC teve diminuição significativa, em todos os momentos analisados após a aspiração, comparando com o momento imediato pós-oxigenação, no SAA. Também foi evidenciado aumento (p=0,03) no valor de volume corrente (VT), quando comparado o momento 31 minutos do SFA com o SAA. Conclusão: Apesar de apresentar alterações significativas, em algumas variáveis, quando comparados os sistemas, as modificações se mantiveram dentro da normalidade e retornaram ao valor basal em uma hora após a aspiração. (AU)

The goal was to compare the closed suction system - CSS to the open suction system - OSS and, for each system, compare hemodynamic and respiratory parameters in different moments. The group was comprised of mechanically ventilated adult patients in pos operatory period. Variables were recorded before CSS adaptation, 15 and 30 minutes after CSS adaptation , immediately after post-oxygenation aspiration with CSS, 6, 16, 31 and 61 minutes after aspiration with CSS. The same process was repeated for the OSS. Forty patients were included. When compared the post-oxygenation increased heart rate was found (p=0,04) to the 6 minutes after CSS, decreased heart rate after 31 minutes (p=0.034) and 61 minutes (p=0,032) after CSS. It was observed that the HR was significantly reduced at all times examined after aspiration, compared to the time immediately post-oxygenation for the OSS. It was also demonstrated an increase (p = 0.03) in the amount of tidal volume (TV), when CSS was compared to the OSS 31 minutes after suction. Despite showing significant changes in some variables, it remained within the normal range and returned to baseline one hour after suction. (AU)

Estatus ponderal y aptitud cardiorrespiratoria en escolares de la región central del Perú / Weight status and cardiorespiratory fitness in school students in the central region of Peru

Objetivos. Determinar la frecuencia del sobrepeso y obesidad, en función a los niveles de aptitud cardiorrespiratoria (AptCR) en escolares de cuatro distritos de la región central del Perú, y analizar la asociación entre estas variables. Materiales y métodos. El peso, altura y la AptCR fueron evaluados en 7841 escolares que residen en cuatro distritos ubicados en la costa, sierra y selva de la región central del Perú. El sobrepeso y la obesidad fueron clasificados según los criterios propuestos por Cole. La AptCR fue evaluada mediante la prueba de correr/caminar de doce minutos de la batería de la American Alliance for Health, Recreation and Dance. Se utilizó el ANOVA y la regresión logística para examinar las diferencias de las medias y asociaciones entre estas variables. Resultados. Escolares de ambos sexos presentan frecuencias semejantes de sobrepeso y obesidad (20,9% en mujeres y 20,1% en varones). Residentes en la costa (Barranco) manifiestan elevadas frecuencias de sobrepeso y obesidad (37,8%). La edad, el sexo, área geográfica y la AptCR fueron predictores significativos para el sobrepeso y la obesidad. Escolares que viven en Barranco tienen cinco veces más probabilidades de ser obesos (OR=4,67; IC95%: 3,55-6,14); los que residen en la sierra (Junín) tienen una menor probabilidad de ser obesos (OR=0,03; IC95%: 0,01-0,20); y quienes muestran una baja AptCR tienen una mayor probabilidad de ser obesos (OR=11 ,82; IC95%: 7,25-19,27), en comparación con aquellos con alta AptCR. Conclusiones. Los escolares que residen en Barranco presentan frecuencias de sobrepeso y obesidad elevados. Una baja AptCR está asociada al desarrollo del sobrepeso y la obesidad.

Objectives. To determine the frequency of overweight and obesity in relation to cardiorespiratory fitness (CRF) levels in school students in 4 districts of the central region of Peru, and to analyze the relations among these variables. Materials and methods. Weight, height and CRF were evaluated in 7841 school students who reside in four districts located on the coast, in the highlands and in the jungle of the central region of the country. Overweight and obesity were classified according to the criteria proposed by Cole. CRF was evaluated by a 12-minute run/walk test taken from the American Alliance for Health, Physical Education, Recreation and Dance’s test battery. ANOVA and logistic regression were used to examine the differences of the averages and the associations among these variables. Results. Both male and female school students have similar frequency of overweight and obesity (20.9% in women and 20.1% in men). Residents of the coast (Barranco) presen thigh frequency of overweight and obesity (37.8%). Age, sex, geographical area and CRF were significant predictors of overweight and obesity. School students who live in Barranco are five times more likely to be obese (OR=4.67; CI95%: 3.55-6.14), while those who reside in the highlands (Junin) are less likely to be obese (OR=0.03; CI95%: 0.01-0.20). Furthermore, in contrast with students with high CRF, those with low CRF are more likely to be obese (OR=11.82; CI95%: 7.25-19.27). Conclusions. There was a high frequency of overweight and obesity among school students who reside in Barranco. Low CRF is associated with overweight and obesity.