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Article: Mesenteric blood flow response to feeding after systemic-to-pulmonary arterial shunt palliation

TitleMesenteric blood flow response to feeding after systemic-to-pulmonary arterial shunt palliation
Authors
Issue Date2003
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/athoracsur
Citation
Annals Of Thoracic Surgery, 2003, v. 75 n. 3, p. 947-951 How to Cite?
AbstractBackground. We hypothesized that the splanchnic circulation protects against diastolic steal through a systemic-to-pulmonary arterial shunt by reducing its resistance. To test the hypothesis we compared the basal and postprandial mesenteric blood flow velocities and vascular resistance in infants after shunt palliation for their underlying cyanotic heart disease with those in nonshunted infants. Methods. The basal and postprandial superior mesenteric arterial (SMA) time-average flow velocity (TAMV), end-diastolic flow velocity (EDFV), and relative resistance were assessed in 23 infants with congenital heart disease. The findings in the 9 shunted infants (group I) were compared with those in 14 nonshunted ones (group II). Results. In group II, TAMV (0.25 ± 0.07 versus 0.33 ± 0.09 m/s, p < 0.001) and EDFV (0.08 ± 0.04 versus 0.11 ± 0.04 m/s, p = 0.003) increased, while SMA relative resistance decreased (297 ± 121 versus 198 ± 73 mm Hg/ms-1, p < 0.001) postprandially. Similarly, in group I, TAMV (0.35 ± 0.13 versus 0.48 ± 0.19 m/s, p = 0.008) increased, while SMA relative resistance decreased (182 ± 61 versus 116 ± 38 mm Hg/ms-1, p = 0.005) after feeding. However, whereas basal and postprandial diastolic flow was antegrade in group II, absent or retrograde diastolic flow was characteristic of group I (preprandial, -0.10 ± 0.07 m/s; postprandial, -0.13 ± 0.06 m/s). Furthermore, group I had significantly lower SMA relative resistance both before (p = 0.02) and after (p = 0.006) feeding. Conclusions. Profound disturbance of splanchnic perfusion occurs in infants palliated with a systemic-to-pulmonary arterial shunt. Their basal and postprandial SMA diastolic blood flow is either absent or reversed. The lowering of basal and postprandial resistance of the splanchnic circulation probably represents an adaptive mechanism to counteract such diastolic steal. © 2003 by The Society of Thoracic Surgeons.
Persistent Identifierhttp://hdl.handle.net/10722/170325
ISSN
2015 Impact Factor: 2.975
2015 SCImago Journal Rankings: 1.490
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheung, YFen_US
dc.contributor.authorHo, MHKen_US
dc.contributor.authorCheng, VYWen_US
dc.date.accessioned2012-10-30T06:07:30Z-
dc.date.available2012-10-30T06:07:30Z-
dc.date.issued2003en_US
dc.identifier.citationAnnals Of Thoracic Surgery, 2003, v. 75 n. 3, p. 947-951en_US
dc.identifier.issn0003-4975en_US
dc.identifier.urihttp://hdl.handle.net/10722/170325-
dc.description.abstractBackground. We hypothesized that the splanchnic circulation protects against diastolic steal through a systemic-to-pulmonary arterial shunt by reducing its resistance. To test the hypothesis we compared the basal and postprandial mesenteric blood flow velocities and vascular resistance in infants after shunt palliation for their underlying cyanotic heart disease with those in nonshunted infants. Methods. The basal and postprandial superior mesenteric arterial (SMA) time-average flow velocity (TAMV), end-diastolic flow velocity (EDFV), and relative resistance were assessed in 23 infants with congenital heart disease. The findings in the 9 shunted infants (group I) were compared with those in 14 nonshunted ones (group II). Results. In group II, TAMV (0.25 ± 0.07 versus 0.33 ± 0.09 m/s, p < 0.001) and EDFV (0.08 ± 0.04 versus 0.11 ± 0.04 m/s, p = 0.003) increased, while SMA relative resistance decreased (297 ± 121 versus 198 ± 73 mm Hg/ms-1, p < 0.001) postprandially. Similarly, in group I, TAMV (0.35 ± 0.13 versus 0.48 ± 0.19 m/s, p = 0.008) increased, while SMA relative resistance decreased (182 ± 61 versus 116 ± 38 mm Hg/ms-1, p = 0.005) after feeding. However, whereas basal and postprandial diastolic flow was antegrade in group II, absent or retrograde diastolic flow was characteristic of group I (preprandial, -0.10 ± 0.07 m/s; postprandial, -0.13 ± 0.06 m/s). Furthermore, group I had significantly lower SMA relative resistance both before (p = 0.02) and after (p = 0.006) feeding. Conclusions. Profound disturbance of splanchnic perfusion occurs in infants palliated with a systemic-to-pulmonary arterial shunt. Their basal and postprandial SMA diastolic blood flow is either absent or reversed. The lowering of basal and postprandial resistance of the splanchnic circulation probably represents an adaptive mechanism to counteract such diastolic steal. © 2003 by The Society of Thoracic Surgeons.en_US
dc.languageengen_US
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/athoracsuren_US
dc.relation.ispartofAnnals of Thoracic Surgeryen_US
dc.subject.meshBlood Flow Velocity - Physiologyen_US
dc.subject.meshCardiac Output - Physiologyen_US
dc.subject.meshEchocardiography, Doppleren_US
dc.subject.meshEnteral Nutritionen_US
dc.subject.meshFemaleen_US
dc.subject.meshHeart Defects, Congenital - Physiopathology - Surgeryen_US
dc.subject.meshHumansen_US
dc.subject.meshInfanten_US
dc.subject.meshInfant, Newbornen_US
dc.subject.meshMaleen_US
dc.subject.meshMesenteric Artery, Superior - Physiopathologyen_US
dc.subject.meshPalliative Careen_US
dc.subject.meshPostprandial Period - Physiologyen_US
dc.subject.meshPulmonary Artery - Surgeryen_US
dc.subject.meshSplanchnic Circulation - Physiologyen_US
dc.subject.meshUltrasonography, Doppler, Coloren_US
dc.subject.meshVascular Resistance - Physiologyen_US
dc.titleMesenteric blood flow response to feeding after systemic-to-pulmonary arterial shunt palliationen_US
dc.typeArticleen_US
dc.identifier.emailCheung, YF:xfcheung@hku.hken_US
dc.identifier.authorityCheung, YF=rp00382en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1016/S0003-4975(02)04627-1en_US
dc.identifier.pmid12645722-
dc.identifier.scopuseid_2-s2.0-0037336554en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0037336554&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume75en_US
dc.identifier.issue3en_US
dc.identifier.spage947en_US
dc.identifier.epage951en_US
dc.identifier.isiWOS:000181431100041-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridCheung, YF=7202111067en_US
dc.identifier.scopusauthoridHo, MHK=8925896400en_US
dc.identifier.scopusauthoridCheng, VYW=7005529517en_US

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