Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-26T06:27:39.305Z Has data issue: false hasContentIssue false
  • English
  • Français

Cardiac dimensions during extracorporeal membrane oxygenation

Published online by Cambridge University Press:  13 July 2005

Ronald B. Tanke ,
Otto Daniëls ,
Arno F. van Heijst ,
Henk van Lier  and
Cees Festen
Ronald B. Tanke
Affiliation:
Children's Heart Center, University Medical Center St Radboud, Nijmegen, The Netherlands
Otto Daniëls
Affiliation:
Children's Heart Center, University Medical Center St Radboud, Nijmegen, The Netherlands
Arno F. van Heijst
Affiliation:
Department of Neonatology, University Medical Center St Radboud, Nijmegen, The Netherlands
Henk van Lier
Affiliation:
Department of Medical Statistics, University Medical Center St Radboud, Nijmegen, The Netherlands
Cees Festen
Affiliation:
Department of Pediatric Surgery, University Medical Center St Radboud, Nijmegen, The Netherlands
Get access Rights & Permissions [Opens in a new window]

Abstract

Our aim was to analyze left ventricular fractional shortening during extracorporeal membrane oxygenation under the influence of changing volume loading conditions induced by a ductal left-to-right shunt. In all patients, the fractional shortening was observed using echocardiography before, during, and after bypass, irrespective of the presence or absence of the ductal left-to-right shunt. During membrane oxygenation, there was a significant decrease in fractional shortening (p less than 0.001), with no difference before and after membrane oxygenation. A greater decrease in fractional shortening was observed in the group with a ductal left-to-right shunt when compared to patients lacking the ductal shunt (p less than 0.006). The diastolic diameter of the left ventricle also increased significantly during the membrane oxygenation in those patients with left-to-right ductal shunting. Moreover, the patients with left-to-right shunting showed a very severe decreased fractional shortening, lower than 10 per cent, with significantly greater frequency (p less than 0.05) during the course of membrane oxygenation. Conclusion: An important decrease in left ventricular fractional shortening is observed during veno-arterial extracorporeal membrane oxygenation. Left-to-right shunting during bypass, as seen in the patients with patency of the arterial duct, increases the loading conditions on the left ventricle, and produces a significant increase in left ventricular diastolic dimensions. Despite the effects of volume loading produced by the ductal shunt during bypass, the decrease in fractional shortening is significantly more pronounced for these patients. Therefore, during membrane oxygenation the volume loading produced by the ductal shunt is unable to prevent a decrease in left ventricular fractional shortening.

Keywords

Patent ductus arteriosuspatency of arterial ductintensive careleft ventricular dimensions
Type
Original Article
Information
Cardiology in the Young , Volume 15 , Issue 4 , August 2005 , pp. 373 - 378
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mason DT. Afterload reduction and cardiac performance. Physiologic basis of systemic vasodilators as a new approach in treatment of congestive heart failure. Am J Med 1978; 65: 106–125.Google Scholar
Rosenqvist M, Isaaz K, Botvinick EH, et al. Relative importance of activation sequence compared to atrioventricular synchrony in left ventricular function. Am J Cardiol 1991; 67: 148–156.Google Scholar
Martin GR, Short BL. Doppler echocardiographic evaulation of cardiac performance in infants on prolonged extracorporeal membrane oxygenation. Am J Cardiol 1988; 62: 929–934.Google Scholar
Holley DG, Short BL, Karr SS, Martin GR. Mechanisms of change in cardiac performance in infants undergoing extra corporeal membrane oxygenation. Crit Care Med 1994; 22: 1865–1870.Google Scholar
Rudolph AM. Distribution and regulation of blood flow in the fetal and neonatal lamb. Circ Res 1985; 57: 811–821.Google Scholar
Kimball TR, Daniels SR, Weiss RG, et al. Changes in cardiac function during extracorporeal membrane oxygenation for persistent pulmonary hypertension in the newborn infant. J Pediatr 1991; 118: 431–436.Google Scholar
Martin GR. Cardiac changes during prolonged extracorporeal membrane oxygenation. In: Krensman RM, Cornish J (eds). Extracorporeal Life Support. Blackwell Scientific Publishers, Boston, 1993, pp 126–137.
Tanke RB, Daniëls O, Van Lier HJ, Van Heyst AF, Festen C. Neonatal pulmonary hypertension during extracorporeal membrane oxygenation. Cardiol Young 2000; 10: 130–139.Google Scholar
Tanke RB, Daniëls O, Van Heijst A, Van Lier H, Festen C. The influence of ductal L–R shunting during extracorporeal membrane oxygenation. J Ped Surg 2002; 37: 1165–1168.Google Scholar
Nakamura T, Takata M, Arai M, Nakagana S, Miyasaka K. The effect of left-to-right shunting on coronary oxygenation during extracorporeal membrane oxygenation. J Pediatr Surg 1999; 34: 981–985.Google Scholar
Rosenberg EM, Seguin JH. Selection criteria for use of ECLS in neonates. In: Zwischenberger JB, Bartlett RH (eds). ECMO, Extracorporeal Cardiopulmonary Support in Critical Care. Extracorporeal Life Support Organisation, Ann Arbor, 1995, pp 261–273.
Feigenbaum H. Echocardiographic evaluation of cardiac chambers. In: Feigenbaum H (ed.). Echocardiography. Lea & Febiger, Philadelphia, 1986, pp 127–187.
Gutgesell HP, Paquet M, Duff DF, McNamara DG. Evaluation of left ventricular size and function by echocardiography. Results in normal children. Circulation 1997; 56: 457–462.Google Scholar
Ghafour AS, Gutgesell HP. Echocardiographic evaluation of left ventricular function in children with congestive cardiomyopathy. Am J Cardiol 1979; 44: 1332–1338.Google Scholar
Martin GR, Chauvin L, Short BL. Effects of hydralazine on cardiac performance in infants receiving extracorporeal membrane oxygenation. J Pediatr 1991; 118: 944–948.Google Scholar
Hirschl RB, Heiss KF, Bartlett RH. Severe myocardial dysfunction during extracorporeal membrane oxygenation. J Pediatr Surg 1992; 27: 48–53.Google Scholar
Berdjis F, Takahshi M, Lewis AB. Left ventricular performance in neonates on extracorporeal membrane oxygenation. Pediatr Cardiol 1992; 13: 141–145.Google Scholar
Kinsella JP, Gerstmann DR, Rosenberg AA. The effect of extracorporeal membrane oxygenation on coronary perfusion and regional blood flow distribution. Pediatr Res 1991; 31: 80–84.Google Scholar
Strieper MJ, Sharma S, Dooley KJ, Cornish JD, Clark RH. Effects of venovenous extracorporeal membrane oxygenation on cardiac performance as determined by echocardiographic measurements. J Pediatr 1993; 122: 950–955.Google Scholar
Tanke RB, Van Heijst AF, Klaessens JHGM, Daniels O, Festen C. Measurement of the ductal L–R shunt during extracorporeal membrane oxygenation in the lamb. J Pediatr Surg 2004; 39: 43–47.Google Scholar
Kato J, Seo T, Ando H, Takagi H, Ito T. Coronary arterial perfusion during venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 1996; 111: 630–636.Google Scholar