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Am J Physiol Heart Circ Physiol 279: H2335-H2343, 2000;
0363-6135/00 $5.00
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Vol. 279, Issue 5, H2335-H2343, November 2000

Changes in venous return parameters associated with univentricular Fontan circulations

Loïc Macé, Patrice Dervanian, Armand Bourriez, Guy M. Mazmanian, Virginie Lambert, Jean Losay, and Jean-Yves Neveux

Department of Cardiovascular and Pediatric Cardiac Surgery and Experimental Surgical Laboratory, Marie Lannelongue Hospital, Paris-Sud University, 92350 Le Plessis Robinson, France

To clarify the physiology of venous return (Qvr) in Fontan circulations, venous return conductance (Gvr) and mean circulatory filling pressure (Pmcf) were determined in pentobarbital sodium-anesthetized pigs. Relationships between Qvr and right (biventricular, n = 8) or left (Fontan, n = 8) filling pressures are described by straight lines with significant correlation coefficients. Estimated Pmcf values were correlated with observed Pmcf values in either circulations (P <=  0.02). Gvr was smaller in Fontan than in biventricular circulations (4.51 ± 0.36 vs. 7.83 ± 0.69 ml · min-1 · kg-1 · mmHg-1, P = 0.002) and inversely correlated with pulmonary vascular resistances in Fontan circulations (P = 0.01). Estimated Pmcf (20.5 ± 1.4 vs. 11.1 ± 0.9 mmHg, P = 0.001) and observed Pmcf (21.8 ± 1.3 vs. 10.6 ± 0.8 mmHg, P < 0.001) were higher in Fontan versus biventricular circulations, respectively. Pulmonary artery pressure in Fontan circulations was correlated with either Pmcf (P <=  0.04). We conclude that in Fontan circulations 1) pulmonary vascular resistances induce a proportional decrease in Gvr; and 2) volume loading, while increasing Pmcf (similar to pulmonary artery pressure), allows the gradient for Qvr to increase and maintains systemic blood flow at a biventricular level.

heart defect; congenital; single ventricle physiology; mean circulatory filling pressure; venous return conductance


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