Throckmorton AL, Bhavsar SS, Chopski SG, Moskowitz WB. Pneumatically-driven external pressure applicator to augment Fontan hemodynamics: preliminary findings.
Transl Pediatr 2013;
2:148-53. [PMID:
26835310 PMCID:
PMC4729077 DOI:
10.3978/j.issn.2224-4336.2013.10.02]
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Abstract
BACKGROUND
This study investigated the application of circumferentially applied, external pressure to the lower extremities as a preventative measure and long-term clinical treatment strategy for Fontan patients.
OBJECTIVE
We hypothesized that the application of circumferential pressure to the lower limbs will augment venous return and thus cardiac output.
METHODS
Two patients (an extra-cardiac and intra-atrial Fontan) were evaluated. Both trials were conducted during a routine cardiac catheterization. The aortic and inferior vena cava (IVC) pressures were recorded. We applied three different external pressures to the lower limbs based on the patient's diastolic pressure. Each pressure was applied with a one-minute rapid inflate/deflate period for a total of five cycles and a rest period between pressure intervals.
RESULTS
Patient 1 (age 37, female) demonstrated pressure rises of 10-15 mmHg in both the aortic and IVC pressures. Patient 2 (age 24, male) had undetectable pressure rise during the first pressure cycles and notable pressures rise of approximately 8-12 mmHg during the third cycle.
CONCLUSIONS
External pressure application redistributes blood volume or cardiac output as a result of impedance in the lower extremities, enhancing venous pressure and return. Our findings strongly suggest an acute benefit from the implementation of external mechanical compression of the lower vasculature to increase cardiac output in Fontan patients.
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