title: Non-invasive cardiac output monitoring during catheter interventions in patients with cavopulmonary circulations.
abstract: BACKGROUND
  Functionally univentricular hearts palliated with superior or total cavopulmonary connection result in circulations in series. The absence of a pre-pulmonary pump means that cardiac output is more difficult to adjust and control. Continuous monitoring of cardiac output is crucial during cardiac catheter interventions and can provide new insights into the complex physiology of these lesions.
  
  
  METHODS
  The Icon cardiac output monitor was used to study the changes in cardiac output during catheter interventions in 15 patients (median age: 6.1 years, range: 4.8-15.3 years; median weight: 18.5 kg, range: 15-63 kg) with cavopulmonary circulations. A total of 19 interventions were undertaken in these patients and the observed changes in cardiac output were recorded and analysed.
  
  
  RESULTS
  Cardiac output was increased with creation of stent fenestrations after total cavopulmonary connection (median increase of 22.2, range: 6.7%-28.6%) and also with drainage of significant pleural effusions (16.7% increase). Cardiac output was decreased with complete or partial occlusion of fenestrations (median decrease of 10.6, range: 7.1%-13.4%). There was a consistent increase in cardiac output with stenting of obstructive left pulmonary artery lesions (median increase of 7.7, range: 5%-14.3%, p = 0.007).
  
  
  CONCLUSIONS
  Icon provides a novel technique for the continuous, non-invasive monitoring of cardiac output. It provides a further adjunct for monitoring of physiologically complex patients during catheter interventions. These results are consistent with previously reported series involving manipulation of fenestrations. This is the first report identifying an increase in cardiac output with stenting of obstructive pulmonary arterial lesions.
authors.affiliation: The Heart Unit, Birmingham Children's Hospital, Cardiology, Birmingham, United Kingdom.
authors.forename: Patrick Michael Emmet
authors.initials: PM
authors.lastname: Noonan
authors.affiliation: The Heart Unit, Birmingham Children's Hospital, Cardiology, Birmingham, United Kingdom.
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Viswanathan
authors.affiliation: The Heart Unit, Birmingham Children's Hospital, Cardiology, Birmingham, United Kingdom.
authors.forename: Amy
authors.initials: A
authors.lastname: Chambers
authors.affiliation: The Heart Unit, Birmingham Children's Hospital, Cardiology, Birmingham, United Kingdom.
authors.forename: Oliver
authors.initials: O
authors.lastname: Stumper
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization; D002302:Cardiac Output; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods*