Effects of arteriovenous shunt on ventricular function in dog.
BACKGROUND
The bidirectional cavopulmonary shunt has been increasingly accepted as an interim step to the Fontan operation. However, the effect(s) of chronic volume overload on ventricular function are not yet well understood.


METHODS
Twelve mongrel dogs, with (chronic volume overload group), or without (control group) a femoral arteriovenous shunt created 8 weeks before the assessment, were subjected to a right heart bypass from the right atrium to the proximal pulmonary trunk. Nonpulsatile perfusion via the bypass was achieved using a centrifugal pump and cross-clamping of the pulmonary trunk. Left ventricular function was evaluated using the end-systolic elastance and the Doppler flow pattern on echocardiograms (epicardiac and transesophageal, simultaneously) during acute volume loading.


RESULTS
The left ventricular weight and the left ventricular weight/end-diastolic volume ratio showed no change from control values. The sum of the isovolumetric contraction time and the isovolumetric relaxation time divided by the ejection time remained constant during acute volume loading in the chronic volume overload group, while an increase was demonstrated in the control group. The chronic volume overload group showed a lower Ees (30.8 +/- 16.4 mmHg/cm2 vs. 107.6 +/- 70.3 mmHg/cm2, p = 0.03) than the control group.


CONCLUSIONS
The global ventricular performance changed with chronic adaptation to the arteriovenous shunt, and became resistant to acute volume loading. Left ventricular contractility under nonpulsatile pulmonary perfusion was impaired by chronic volume overload, which is deleterious to the Fontan operation.
Omoto
T
T
Division of Cardiovascular Surgery, Keio University, Tokyo, Japan.
Aeba
R
R
Katogi
T
T
Ito
T
T
Kawada
S
S
D000818:Animals; D001166:Arteriovenous Shunt, Surgical; D004285:Dogs; D005263:Femoral Artery / Q000601:surgery; D005268:Femoral Vein / Q000601:surgery; D018729:Fontan Procedure; D018610:Heart Bypass, Right; D016277:Ventricular Function, Left