Bidirectional cavopulmonary connection without additional pulmonary blood flow in patients below the age of 6 months☆

The superior cavopulmonary connection (SCPC) or “bidirectional Glenn” is an integral, intermediate stage in palliation of single ventricle patients to the Fontan procedure. The procedure, normally performed at 3 to 6 months of life, increases effective pulmonary blood flow and reduces the ventricular volume load in patients with single ventricle (parallel circulation) physiology. While the SCPC, with or without additional sources of pulmonary blood flow, cannot be considered a long-term palliation strategy, there are a subset of patients who require SCPC palliation for a longer interval than the typical patient. In this article, we will review the physiology of SCPC, the consequences of prolonged SCPC palliation, and modes of failure. We will also discuss strategies to augment pulmonary blood flow in the presence of an SCPC. The anesthetic considerations in SCPC patients will also be discussed, as these patients may present for noncardiac surgery from infancy to adulthood.

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Possible sources of right-to-left shunting in patients following a total cavopulmonary connection

Cardiology in the Young ◽

10.1017/s1047951100006879 ◽

1998 ◽

Vol 8 (3) ◽

pp. 358-363 ◽

Cited By ~ 8

Author(s):

Gernot Buheitel ◽

Michael Hofbeck ◽

Ursula Tenbrink ◽

Georg Leipold ◽

Jürgen v.d. Emde ◽

...

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Arterial Oxygen Saturation ◽

Pulmonary Veins ◽

Arterial Oxygen ◽

Total Cavopulmonary Connection ◽

Systemic Blood ◽

Systemic Blood Flow ◽

Arteriovenous Fistulas ◽

Cavopulmonary Connection

AbstractDespite a good haemodynamic result, many children have amildly decreased arterial oxygen saturation following a total cavopulmonary connection. Our study was performed to determine possible mechanisms of right-to-left shunting in these patients. We performed elective cardiac catheterization in 19 children at a mean interval of 3.6 years following a total cavopulmonary connection. The intrapulmonary right-to-left shunt, the intracardiac right-to-left shunt and the total right-to-left shunt were calculated under mechanical ventilation with 100% oxygen. The intrapulmonary right-to-left shunt was 10.8±3.5% of the pulmonary blood flow, and the total right-to left shunt accounted for 18.9±5.2% of the systemic blood flow. The intracardiac right-to-left shunt in patients with no relevant venovenous collaterals or leaks in the atrial tunnel was calculated at 6.4±3.0% of the systemic blood flow, while the intracardiac right-to-left shunt in patients with relevant collaterials or leaks accounted for 13.0±5.9% of the systemic blood flow. Since intrapulmonary arteriovenous fistulas were not demonstrated angiographically in any of our patients, the intrapulmonary right-to-left shunt is probably due to low ratios of perfusion to ventilation in some pulmonary segments. The intracafdiac right-to-left shunt was due to leaks across the interatrial baffle, collaterals between stystemic and pulmonary veins, and to the coronary sinus draining to the pulmonary venous atrium.

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Comparison of Outcomes at Time of Superior Cavopulmonary Connection Between Single Ventricle Patients With Ductal-Dependent Pulmonary Blood Flow Initially Palliated With Either Blalock-Taussig Shunt or Ductus Arteriosus Stent

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.119.008110 ◽

2019 ◽

Vol 12 (10) ◽

Cited By ~ 2

Author(s):

Jeffery J. Meadows ◽

Athar M. Qureshi ◽

Bryan H. Goldstein ◽

Christopher J. Petit ◽

Courtney E. McCracken ◽

...

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Single Ventricle ◽

Ductus Arteriosus ◽

Cavopulmonary Connection ◽

Blalock Taussig Shunt

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A Hemi Fontan Operation Performed by an Engineer: Considerations on Virtual Surgery

Volume 1B: Extremity; Fluid Mechanics; Gait; Growth, Remodeling, and Repair; Heart Valves; Injury Biomechanics; Mechanotransduction and Sub-Cellular Biophysics; MultiScale Biotransport; Muscle, Tendon and Ligament; Musculoskeletal Devices; Multiscale Mechanics; Thermal Medicine; Ocular Biomechanics; Pediatric Hemodynamics; Pericellular Phenomena; Tissue Mechanics; Biotransport Design and Devices; Spine; Stent Device Hemodynamics; Vascular Solid Mechanics; Student Paper and Design Competitions ◽

10.1115/sbc2013-14451 ◽

2013 ◽

Author(s):

Giovanni Biglino ◽

Ethan Kung ◽

Adam Dorfman ◽

Andrew M. Taylor ◽

Edward Bove ◽

...

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Fontan Operation ◽

Hybrid Approach ◽

Pulmonary Arteries ◽

Virtual Surgery ◽

Extracardiac Conduit ◽

Lateral Tunnel ◽

The Right ◽

Cavopulmonary Connection

Single ventricle circulation, characterized at birth by a rudimentary or absent left or right ventricle, presents a challenging and life-threatening physiological scenario. Surgical palliation aims to restore the balance between systemic and pulmonary blood flow and is staged, each of the three stages presenting the surgeon with different options: - Stage 1 (Norwood procedure) involves different types of shunting to source pulmonary blood flow, or recently a hybrid approach [1]; - Stage 2 can involve a superior cavopulmonary connection (Glenn operation) or patching between the right atrium and the pulmonary arteries (Hemi Fontan operation [2]); - Stage 3 involves a total cavopulmonary connection with extracardiac conduit or lateral tunnel, or with novel alternatives such as the Y-graft [3].

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