Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-15T03:23:15.904Z Has data issue: false hasContentIssue false
  • English
  • Français

Blood reservoir function in patients with Fontan circulation and asplenia syndrome

Published online by Cambridge University Press:  21 June 2019

Michitaka Fuse ,
Kenji Sugamoto ,
Seiko Kuwata ,
Rika Sekiya ,
Kohei Kawada ,
Miku Toki ,
Masahiro Kaneko ,
Yoichi Iwamoto ,
Hirotaka Ishido  and
Satoshi Masutani
...Show all authors
Michitaka Fuse
Affiliation:
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Kenji Sugamoto
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Seiko Kuwata
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Rika Sekiya
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Kohei Kawada
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Miku Toki
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Masahiro Kaneko
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Yoichi Iwamoto
Affiliation:
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Hirotaka Ishido
Affiliation:
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Satoshi Masutani
Affiliation:
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Manabu Kenmochi
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Hirofumi Saiki
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
Hideaki Senzaki*
Affiliation:
Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
*
Author for correspondence: Prof. Hideaki Senzaki, MD, Department of Pediatrics, Pediatric Cardiology, Kitasato University School of Medicine, IPE Building 413, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan. Tel: +81-42-778-8192; Fax: +81-42-778-8441; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Splanchnic circulation constitutes a major portion of the vasculature capacitance and plays an important role in maintaining blood perfusion. Because patients with asplenia syndrome lack this vascular bed as a blood reservoir, they may have a unique blood volume and distribution, which may be related to their vulnerability to the haemodynamic changes often observed in clinical practice. During cardiac catheterisation, the mean circulatory filling pressure was calculated with the Valsalva manoeuvre in 19 patients with Fontan circulation, including 5 patients with asplenia syndrome. We also measured the cardiac output index and circulatory blood volume by using a dye dilution technique. The blood volume and the mean circulatory filling pressure and the venous capacitance in patients with asplenia syndrome were similar to those in the remaining patients with Fontan circulation (85 ± 14 versus 77 ± 18 ml/kg, p = 0.43, 31 ± 8 versus 27 ± 5 mmHg, p = 0.19, 2.8 ± 0.6 versus 2.9 ± 0.9 ml/kg/mmHg, p = 0.86). Unexpectedly, our data indicated that patients with asplenia syndrome, who lack splanchnic capacitance circulation, have blood volume and venous capacitance comparable to those in patients with splanchnic circulation. These data suggest that (1) there is a blood reservoir other than the spleen even in patients with asplenia; (2) considering the large blood pool of the spleen, the presence of a symmetrical liver may represent the possible organ functioning as a blood reservoir in asplenia syndrome; and (3) if this is indeed the case, there may be a higher risk of hepatic congestion in patients with Fontan circulation with asplenia syndrome than in those without.

Keywords

Vascular capacitanceaspleniamean circulatory filling pressure
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 8 , August 2019 , pp. 1016 - 1019
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

These authors contributed equally to this work.

References

Wadenvik, H, Kutti, J. The spleen and pooling of blood cells. Eur J Haematol 1988; 41: 1–5.CrossRefGoogle ScholarPubMed
Sandler, MP, Kronenberg, MW, Forman, MB, Wolfe, OH, Clanton, JA, Partain, CL. Dynamic fluctuations in blood and spleen radioactivity: splenic contraction and relation to clinical radionuclide volume calculations. J Am Coll Cardiol 1984; 3: 1205–1211.CrossRefGoogle ScholarPubMed
Flamm, SD, Taki, J, Moore, R, et al. Redistribution of regional and organ blood volume and effect on cardiac function in relation to upright exercise intensity in healthy human subjects. Circulation 1990; 81: 1550–1559.CrossRefGoogle ScholarPubMed
Hurford, WE, Hong, SK, Park, YS, et al. Splenic contraction during breath-hold diving in the Korean ama. J Appl Physiol (Bethesda, Md : 1985) 1990; 69: 932–936.10.1152/jappl.1990.69.3.932CrossRefGoogle ScholarPubMed
Schagatay, E, Andersson, JP, Hallen, M, Palsson, B. Selected contribution: role of spleen emptying in prolonging apneas in humans. J Appl Physiol (Bethesda, Md : 1985) 2001; 90: 1623–1629; discussion 1606.CrossRefGoogle ScholarPubMed
Espersen, K, Frandsen, H, Lorentzen, T, Kanstrup, IL, Christensen, NJ. The human spleen as an erythrocyte reservoir in diving-related interventions. J Appl Physiol (Bethesda, Md : 1985) 2002; 92: 2071–2079.CrossRefGoogle ScholarPubMed
Schagatay, E, Haughey, H, Reimers, J. Speed of spleen volume changes evoked by serial apneas. Eur J Appl Physiol 2005; 93: 447–452.CrossRefGoogle ScholarPubMed
Oka, T, Itoi, T, Hamaoka, K. Impaired transient elevation of blood hemoglobin in response to acute hypoxia in neonates with asplenia. Pediatr Int 2007; 49: 898–902.CrossRefGoogle ScholarPubMed
Turner, AW, Hodgetts, VE. The dynamic red cell storage function of the spleen in sheep. I. Relationship to fluctuations of jugular haematocrit. Aust J Exp Biol Med Sci 1959; 37: 399–420.CrossRefGoogle ScholarPubMed
Guntheroth, WG. In vivo measurement of dimensions of veins with implications regarding control of venous return. IEEE Trans Biomed Eng 1969; 16: 247–253.CrossRefGoogle ScholarPubMed
Ohishi, K, Muteki, T, Shinozaki, M, et al. Clinical significance of mean circulatory filling pressure and cardiac preload under anesthesia. J Anesth 1987; 1: 35–43.CrossRefGoogle ScholarPubMed
Masutani, S, Kurishima, C, Yana, A, et al. Assessment of central venous physiology of Fontan circulation using peripheral venous pressure. J Thorac Cardiovasc Surg 2017; 153: 912–920.CrossRefGoogle ScholarPubMed
Liang, F, Senzaki, H, Kurishima, C, Sughimoto, K, Inuzuka, R, Liu, H. Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study. Am J Physiol Heart Circ 2014; 307: H1056–H1072.CrossRefGoogle ScholarPubMed
Mace, L, Dervanian, P, Bourriez, A, et al. Changes in venous return parameters associated with univentricular Fontan circulations. Am J Physiol Heart Circ 2000; 279: H2335–H2343.CrossRefGoogle ScholarPubMed
Kurishima, C, Saiki, H, Masutani, S, Senzaki, H. Tailored therapy for aggressive dilatation of systemic veins and arteries may result in improved long-term Fontan circulation. J Thorac Cardiovasc Surg 2015; 150: 1367–1370.CrossRefGoogle ScholarPubMed
Kim, J, Kuwata, S, Kurishima, C, et al. Importance of dynamic central venous pressure in Fontan circulation. Heart Vessels 2018; 33: 664–670.CrossRefGoogle ScholarPubMed
Goy, RW, Chiu, JW, Loo, CC. Pulse dye densitometry: a novel bedside monitor of circulating blood volume. Ann Acad Med Singapore 2001; 30: 192–198.Google ScholarPubMed