title: Cerebral circulation in patients with Fontan circulation: assessment by carotid arterial wave intensity and stiffness.
abstract: BACKGROUND
  Information about the cerebral circulation in the Fontan physiology is scarce. We tested our hypothesis that cerebral perfusion is impaired in the Fontan circulation by analyzing wavefront behavior (wave intensity) and assessing arterial stiffness at the carotid artery.
  
  
  METHODS
  The carotid arterial wave intensity and stiffness were computed in 34 consecutive Fontan patients (11.5±8.6 years) and 20 control subjects (13.4±6.0 years) using an echocardiographic vascular tracking system, which enabled simultaneous measurements of instantaneous carotid arterial pressure and flow velocity.
  
  
  RESULTS
  The carotid arterial blood flow was significantly lower in the Fontan patients than in the controls (p<0.05). Wave intensity analysis demonstrated a significant decrease in the compression and acceleration wave, an important forward traveling wave for cerebral circulation, in the Fontan patients compared with the control subjects (31.0±2.6 versus 48.1±4.4 mm Hg⋅m⋅s3⋅10(3); p=0.001). In addition, the negative wave intensity normalized to the first positive wave, representing a wave reflection from peripheral cerebral vessels, was significantly increased in the Fontan patients compared with that in control subjects. Carotid arterial stiffness and central venous pressure were also significantly increased in the Fontan patients and were independent determinants of the decreased first positive wave, suggesting the pathophysiologic importance of carotid arterial stiffness and central venous pressure as inflow and outflow resistance to the cerebral circulation, respectively, in the Fontan physiology.
  
  
  CONCLUSIONS
  These results suggest impaired cerebral perfusion caused by vascular stiffening and high central venous pressure in patients with Fontan circulation. Longitudinal studies examining the association between cerebral circulation and neurodevelopmental outcome after Fontan operation are warranted.
authors.affiliation: Department of Pediatric Cardiology and Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Saiki
authors.affiliation: Department of Pediatric Cardiology and Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Clara
authors.initials: C
authors.lastname: Kurishima
authors.affiliation: Department of Pediatric Cardiology and Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Masutani
authors.affiliation: Department of Pediatric Cardiology and Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan. Electronic address: hsenzaki@saitama-med.ac.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Senzaki
mesh_terms: D000293:Adolescent; D002339:Carotid Arteries / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D002648:Child; D005260:Female; D018729:Fontan Procedure; D006801:Humans; D008297:Male; D059289:Vascular Stiffness