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. 1999 Sep;82(3):294–299. doi: 10.1136/hrt.82.3.294

Instantaneous pressure-flow velocity relations of systemic venous return in patients with univentricular circulation

R Kaulitz 1, P Bergman 1, I Luhmer 1, T Paul 1, G Hausdorf 1
PMCID: PMC1729191  PMID: 10455078

Abstract

OBJECTIVE—To assess the pressure and flow velocity relations and respiratory variability of the systemic venous and hepatic venous return in patients with univentricular circulation.
PATIENTS—15 selected patients who had undergone cavopulmonary anastomosis (10) or atriopulmonary anastomosis (5). Mean age at operation was 55.1 months (range 9 to 145). Studies were done at 75.5 (32.6) months (mean (SD)) after the operation.
SETTING—Tertiary referral centre.
METHODS—Patients were studied using simultaneous recordings of ECG, pressure trace, respirometer trace, and pulsed Doppler echocardiography. Mean systemic venous pressure and pulmonary vascular resistance did not differ significantly between the two patient groups.
RESULTS—After total cavopulmonary anastomosis, systemic venous pressure tracings showed a flattened pressure curve without any dependence on cardiac or respiratory cycle. After atriopulmonary anastomosis, right atrial pressure tracings showed a significantly higher "a" wave corresponding to atrial contraction, without any respiratory variability. Pulsed Doppler examination of the superior and inferior caval vein and hepatic vein after total cavopulmonary anastomosis did not show a reverse flow after atrial contraction. The inspiratory to expiratory velocity ratio of antegrade flow revealed a significant dependence of flow on changes in intrathoracic pressure in the intra-atrial tunnel, caval veins, and hepatic vein. During expiration, decrease or cessation of antegrade hepatic venous flow was documented. After an atriopulmonary anastomosis, there was a biphasic antegrade venous flow pattern without significant respiratory variation.
CONCLUSIONS—After total cavopulmonary anastomosis, there was marked respiratory dependence of systemic and hepatic venous return, whereas after an atriopulmonary anastomosis venous flow pattern varied according to cardiac cycle and pressure trace. The effects of total cavopulmonary anastomosis on venous return might counteract its other haemodynamic advantages.


Keywords: Fontan operation; Doppler echocardiography; systemic venous flow pattern

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Figure 1  .

Figure 1  

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Pulsed Doppler recording from the superior caval vein (A) and hepatic vein (B) in a patient after total cavopulmonary anastomosis. The pressure trace within the intra-atrial tunnel showed a flattened curve. The superior caval vein flow profile had some pulsatility with respiratory variability. The hepatic venous flow mirrors respiratory dependence, with cessation or even reversal of flow at expiration.

Figure 2  .

Figure 2  

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Pulsed Doppler recording from the superior caval vein (A) and hepatic vein (B) in a patient after an atriopulmonary anastomosis. Simultaneous right atrial pressure curves (P) and respiratory traces (R) are illustrated. Venous flow pattern showed two flow peaks at systole and diastole, with regurgitant peak flow after the P wave on the ECG.

Selected References

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