The Fontan circulation: who controls cardiac output?
In a Fontan circuit the mechanisms involved in control of cardiac output at rest and during exercise differ significantly from normal. The classical model presumes an unlimited preload which is not available in the Fontan circuit. This review critically analyses the role of contractility, heart rate, and afterload and highlights the importance of pulmonary vascular resistance (PVR) in determining adequate preload and, therefore, cardiac output in these patients. A conceptual model of the determinants of cardiac output in Fontan patients is presented.
Gewillig
Marc
M
Paediatric and Congenital Cardiology, University Hospitals Leuven, Belgium. marc.gewillig@uzleuven.be
Brown
Stephen C
SC
Eyskens
Benedicte
B
Heying
Ruth
R
Ganame
Javier
J
Budts
Werner
W
La Gerche
Andre
A
Gorenflo
Matthias
M
D002302:Cardiac Output; D015444:Exercise; D018729:Fontan Procedure / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008955:Models, Cardiovascular; D009200:Myocardial Contraction; D011652:Pulmonary Circulation; D016896:Treatment Outcome; D014655:Vascular Resistance