Ebook Advances in hemodynamic research: Part 2
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Ebook Advances in hemodynamic research: Part 2
Part II: Clinical Application of Hemodynamic ResearchIn: Advances in Hemodynamics Research Editor: Keiichi ItataniISBN.^rw XX t© 2015 Nova Science Pub Ebook Advances in hemodynamic research: Part 2blishers. Inc.Chapter 6Congenital Heart Disease AND Circulatory PhysiologyTakashi Honda'1, Kagami Miyaji2 and Masahiro Ishii1 ‘Department of Pediatrics. Kitasato University School of Medicine. Japan Department of Cardiovascular Surgery, Kitasato University School of Medicine. JapanAbstractThe physio Ebook Advances in hemodynamic research: Part 2logical basis of congenital heart diseases in most cases is an abnormality in hemodynamics. Therefore, a timely diagnosis based on echocardiography haEbook Advances in hemodynamic research: Part 2
s contributed to the medical practice for patients with congenital heart diseases. Echocardiography has clarified not only the hemodynamics of childrePart II: Clinical Application of Hemodynamic ResearchIn: Advances in Hemodynamics Research Editor: Keiichi ItataniISBN.^rw XX t© 2015 Nova Science Pub Ebook Advances in hemodynamic research: Part 2hocardiography are remarkable. Vector flow mapping echocardiography made it possible to visualize the blood flow and to analyze the energy dynamics. Cardiac magnetic resonance imaging is also a promising imaging modality, because a three-dimensional evaluation and an assessment of the myocardial cha Ebook Advances in hemodynamic research: Part 2racteristics are possible without limitations such as poor echo window, which often affects the hemodynamic evaluation on echocardiography. Owing to rEbook Advances in hemodynamic research: Part 2
ecent innovations in diagnosis, medical treatment and surgical techniques, long- term survival can be expected even in patients with complex congenitaPart II: Clinical Application of Hemodynamic ResearchIn: Advances in Hemodynamics Research Editor: Keiichi ItataniISBN.^rw XX t© 2015 Nova Science Pub Ebook Advances in hemodynamic research: Part 2OÍ' Fallot and single ventricular anomalies. The accumulation of knowledge on the hemodynamics in these adult patients will show us the direction that should be taken to overcome long-term life-threatening complications. In this chapter, we discuss the characteristics of the hemodynamics in patients Ebook Advances in hemodynamic research: Part 2 with CHD from fetus to adult, and propose ways to improve the life expectancy and activities of daily living in patients with CHD.Keywords: congenitaEbook Advances in hemodynamic research: Part 2
l heart disease, right ventricle, single ventricle’ Corresponding Author address E-mail: (honda@ined.kitasato-u.ac.jp.166Takashi Honda. Kagami Miyaji Part II: Clinical Application of Hemodynamic ResearchIn: Advances in Hemodynamics Research Editor: Keiichi ItataniISBN.^rw XX t© 2015 Nova Science Pub Ebook Advances in hemodynamic research: Part 2to the brain and heart, fetal circulation has distinct physiological mechanisms, rhe placenta serves as a site lor gas exchange, and oxygenated blood returns to the ductus venosus thorough the umbilical vein, and well-oxygenated blood fiom the ductus venosus, as well as blood from left hepatic vein, Ebook Advances in hemodynamic research: Part 2 streams into the left atrium and ventricle through the foramen ovale, (Figure 6.1) In contrast, the blood flow from the superior and inferior vena caEbook Advances in hemodynamic research: Part 2
va streams into the right ventricle without passing through the foramen ovale (Rudolph AM 19X5). Several studies using radionuclide-labeled mierospherPart II: Clinical Application of Hemodynamic ResearchIn: Advances in Hemodynamics Research Editor: Keiichi ItataniISBN.^rw XX t© 2015 Nova Science Pub Ebook Advances in hemodynamic research: Part 2us venosus into the inferior vena cava (Bristow cl al. 19X1) and the difference in velocity between the inferior vena cava and the ductus venosus blood flow are considered to contribute to this bl(H>d distribution (Schmidt el al. 1996). In addition, although the pressures in the ascending aorta and Ebook Advances in hemodynamic research: Part 2descending aorta are almost identical, the aortic isthmus serves as a site of functional separation. Rudolph AM 19X5 reported that inflation of a ballEbook Advances in hemodynamic research: Part 2
oon lead a dramatic fall in the right ventricular function, and this study clarified the role of the aortic isthmus as a site of functional separationPart II: Clinical Application of Hemodynamic ResearchIn: Advances in Hemodynamics Research Editor: Keiichi ItataniISBN.^rw XX t© 2015 Nova Science Pub Ebook Advances in hemodynamic research: Part 2ava, and the majority of the blood passes through the foramen ovale into the left atrium and ventricle. And the left ventricle ejects this oxygenated blood flow towards the brain, heart and upper extremities. Therefore, the brain can be supplied with a high amount of oxygen. And the blood flow from Ebook Advances in hemodynamic research: Part 2the superior vena cava subsequently returns to the right atrium, and the majority of the blood flows into the right ventricle, and then provides oxygeEbook Advances in hemodynamic research: Part 2
n for internal organs and lower extremities.hi order to maintain the fetal circulation, patency of foramen ovale and ductus arteriosus, as well as higPart II: Clinical Application of Hemodynamic ResearchIn: Advances in Hemodynamics Research Editor: Keiichi ItataniISBN.^rw XX t© 2015 Nova Science Pub Ebook Advances in hemodynamic research: Part 2anen et al. 1998). Therefore, the fetal circulation would be inhibited if these elements were impaired. For example, premature closure of the foramen ovale is associated with mitral and or aortic atresia.'stenosis and endocardial fibroelastosis, and has also been postulated to be a cause of hypoplas Ebook Advances in hemodynamic research: Part 2tic left heart syndrome (ULUS) (Nowlen et al. 2000). On the other hand, premature closure of the ductus arteriosus causes all of the right ventricularEbook Advances in hemodynamic research: Part 2
output to be ejected into the left and right pulmonary arteries, leading to pulmonary’ hypertension, hl addition, right ventricular dysfunction and tPart II: Clinical Application of Hemodynamic ResearchIn: Advances in Hemodynamics Research Editor: Keiichi ItataniISBN.^rw XX t© 2015 Nova Science Pub Ebook Advances in hemodynamic research: Part 2ugs (NSAIDs) inhibit the synthesis of prostaglandins, the use of NSAIDs for pregnant women would cause of premature closure of the fetal ductus arteriosus (Shastri et al. 2013).Congenital Heart Disease and Circulatory PhysiologyFigure 6.1. The fetal circulation. The blood flow from the placenta retu Ebook Advances in hemodynamic research: Part 2rns to the right atrium through the umbilical vein, and subsequently streams into the left atrium and ventricle through the foramen ovale. As the aortEbook Advances in hemodynamic research: Part 2
ic isthmus works as a site of functional blood flow separation, this well-oxygenated blood flow from the left ventricle mainly supplies oxygen to the Part II: Clinical Application of Hemodynamic ResearchIn: Advances in Hemodynamics Research Editor: Keiichi ItataniISBN.^rw XX t© 2015 Nova Science Pub Ebook Advances in hemodynamic research: Part 2ding oxygen to the internal organs and lower extremities. AAo = ascending aorta. DA = ductus arteriosus. Dao = descending aorta, IVC = inferior vena cava. LA = left atrium. LHV = left hepatic vein. LPA = left pulmonary artery. LV = left ventricle, PA = pulmonary artery, pv = pulmonary vein. RA = rig Ebook Advances in hemodynamic research: Part 2ht ventricle. RHV = right hepatic vein. RPA = right pulmonary artery. RV = right ventricle. SVC = superior vena cava, and ƯV = umbilical vein.There arEbook Advances in hemodynamic research: Part 2
e other unique characteristics associated with the fetal circulation. First, the right ventricle is dominant during the fetal period. The right ventriPart II: Clinical Application of Hemodynamic ResearchIn: Advances in Hemodynamics Research Editor: Keiichi ItataniISBN.^rw XX t© 2015 Nova Science Pub Ebook Advances in hemodynamic research: Part 2seen in fetuses with Ebstein's anomaly, often leads to fetal heart failure or death (Roberson et al. 1989. Oberhoffer et al. 1992). Second, decreasing heart rate by vagal stimulation resulted in a marked decrease in ventricular function. In addition, electrical pacing above the resting rate of 160-1 Ebook Advances in hemodynamic research: Part 280/min caused the ventricular output to reach a maximum of about 15% above the resting level (Rudolph et al. 1976). indicating that the fetal heart isEbook Advances in hemodynamic research: Part 2
functioning near its maximum performance. Third, Thornburg et al. 1983168Takashi Honda. Kagaini Miyaji and Masahiro Ishiireported that reducing the vPart II: Clinical Application of Hemodynamic ResearchIn: Advances in Hemodynamics Research Editor: Keiichi ItataniISBN.^rw XX t© 2015 Nova Science Pub Ebook Advances in hemodynamic research: Part 2 small increase in the cardiac output in fetal lambs. Meanwhile, inflation of a balloon also caused a dramatic decrease in the right ventricular cardiac output (Gilbert et al. 1982). Therefore, it is considered that the fetal ventricle functions are near the top of their performance, and there is li Ebook Advances in hemodynamic research: Part 2ttle functional reserve that can be used in response to increased volume and pressure workload.Figure 6.2. Twin-to-twin transfusion syndrome (TTTS). IEbook Advances in hemodynamic research: Part 2
n twins with TTTS. placental anastomosis vessels allow the blood to pass from one fems (donor twin) to the other (recipient twin). The subsequent circPart II: Clinical Application of Hemodynamic ResearchIn: Advances in Hemodynamics Research Editor: Keiichi ItataniISBN.^rw XX t© 2015 Nova Science Pub Ebook Advances in hemodynamic research: Part 2n increased blood volume, leading to fetal heart failure. Fetoscopic laser photocoagulation (FLP) corrects this circulatory disequilibrium by intercepting the placental anastomosis vessels, leading to improvement of the twins' conditions.Recently, several centers for highly advanced medical treatmen Ebook Advances in hemodynamic research: Part 2t have started fetal cardiac intervention in order to interrupt the progression of diseases based on the prenatal diagnosis, and to subsequently improEbook Advances in hemodynamic research: Part 2
ve the perinatal and lifelong outcomes. Fetoscopic laser photocoaglation (FLP) is a novel treatment for fetuses with twin-to-twin transfusion syndromeGọi ngay
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