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Articles in PresS, published online ahead of print November 8, 2001
Am J Physiol Heart Circ Physiol, 10.1152/ajpheart.00231.2001
Submitted on March 23, 2001
Accepted on November 6, 2001
1 Department of Electronics, Computer Science and Systems, University of Bologna, Bologna, Italy
* To whom correspondence should be addressed. E-mail: mursino{at}deis.unibo.it.
The objective of this study was to determine the impact of a total-cavopulmonary connection on the main hemodynamic quantities both at rest and during exercise, when compared with normal biventricular circulation. The analysis was performed by means of a mathematical model of the cardiovascular system. The model incorporates the main parameters of systemic and pulmonary circulation, the pulsating heart, and the action of arterial and cardiopulmonary baroreflex mechanisms. Furthermore, the effect of changes in intrathoracic pressure on venous return is also incorporated. Finally, the response to moderate dynamical exercise is simulated including the effect of a central command, local metabolic vasodilation, and the "muscle pump" mechanism. Simulations of resting conditions indicate that the action of baroreflex regulatory mechanisms alone can only partially compensate for the absence of the right heart. Cardiac output and mean systemic arterial pressure at rest show a large decrease compared with the normal subject. More acceptable hemodynamic quantity values are obtained by combining the action of regulatory mechanisms with a chronic change in parameters affecting mean filling pressure. Assuming such changes, simulations of the response to moderate exercise show that univentricular circulation exhibits a poor capacity to increase cardiac output and to sustain aerobic metabolism, especially when the oxygen consumption rate is increased above 1.2-1.3 l/min. The model ascribes the poor response to exercise in these patients to the incapacity to sustain venous return, caused by the high resistance to venous return and/or to exhaustion of volume compensation reserve.
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