Perioperative B-type natriuretic peptide levels predict outcome after bidirectional cavopulmonary anastomosis and total cavopulmonary connection

AbstractBackgroundsThe aim of this study was to assess the impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after total cavopulmonary connection.MethodsWe conducted a retrospective analysis of 100 consecutive patients who underwent total cavopulmonary connection from 2010 to 2014. All patients had previously undergone bidirectional cavopulmonary anastomosis. These patients were classified into two groups according to age at bidirectional cavopulmonary anastomosis: younger group, <6 months (n=33), and older group, >6 months (n=67).ResultsThe proportion of hypoplastic left heart syndrome was higher in the younger group (48 versus 4%). After total cavopulmonary connection, the chest tube period was longer in the younger group (10.1±6.6 versus 6.7±4.5 days; p=0.009). Catheterisation 6 months after total cavopulmonary connection revealed that pulmonary artery pressure was higher (11.5±1.9 versus 10.4±2.1 mmHg; p=0.017) and Nakata index was lower (219±79 versus 256±70 mm2/m2; p=0.024) in the younger group. In patients with a non-hypoplastic left heart syndrome, there was no difference in post-operative haemodynamics between two groups, but the total amount of chest drainage after total cavopulmonary connection was larger in the younger group (109±95 versus 55±40 ml/kg; p=0.044).ConclusionsEarly bidirectional cavopulmonary anastomosis did not affect the outcome of total cavopulmonary connection. Longer chest tube period, smaller pulmonary artery, and higher pulmonary artery pressure after total cavopulmonary connection were recognised in early bidirectional cavopulmonary anastomosis patients, especially in hypoplastic left heart syndrome.

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Can we do without routine fenestration in extracardiac total cavopulmonary connections? Report on 84 consecutive patients

Cardiology in the Young ◽

10.1017/s104795110500209x ◽

2006 ◽

Vol 16 (1) ◽

pp. 54-60 ◽

Cited By ~ 12

Author(s):

Christian Schreiber ◽

Martin Kostolny ◽

Jürgen Hörer ◽

Julie Cleuziou ◽

Klaus Holper ◽

...

Keyword(s):

High Risk ◽

Arterial Pressure ◽

Pulmonary Arterial Pressure ◽

Total Cavopulmonary Connection ◽

Mean Pulmonary Arterial Pressure ◽

Increased Risk ◽

Cavopulmonary Anastomosis ◽

Pulmonary Arterial ◽

Bidirectional Cavopulmonary Anastomosis ◽

Cavopulmonary Connection

Fenestration is still widely used in right heart bypass operations. Our study was conducted to assess its need in the most recent modification, the completion of a total cavopulmonary connection with an extracardiac tube.The extracardiac approach was introduced at our institution in January, 1999. Since June of 2000, no patient had a fenestration. If more than 1 risk factor amongst ventricular function being more than moderately impaired, atrioventricular valvar regurgitation more than moderate, mean pulmonary arterial pressure more than 15 millimetres of mercury, mean atrial pressure higher than 12 millimetres of mercury, pulmonary arterial distortion, or other than sinus rhythm was present preoperatively, the patient was considered a “high risk” candidate. Postoperatively elevated pulmonary arterial pressure higher than 16 millimetres of mercury, prolonged effusions and requirement for drainage longer than 7 days, and death were considered endpoints in the statistical analysis.Our study group included 84 patients who underwent surgery up to August, 2004. A previous bidirectional cavopulmonary anastomosis had been accomplished in 73 patients at a mean age of 27.01 plus or minus 32.60 months, with a median of 11.5 months, without creating an additional source of flow of blood to the lungs.At the time of the total cavopulmonary connection, the mean age was 66.4 plus or minus 60.1 months, with a median of 37.1 months, and a range from 17.3 to 251.2 months, with 50 patients being younger than 48 months.We deemed 16 patients to be at “high risk”. These patients were older at the time of bidirectional cavopulmonary anstomosis (p smaller than 0.016), at the time of completion (p smaller than 0.019), and also differed in size at time of completion (p smaller than 0.020). They required a longer time on cardiopulmonary bypass (p smaller than 0.015), and reached higher early postoperative pulmonary arterial pressures after completion (p smaller than 0.025). There were no differences between groups of patients having up to 1 or more risk factors in regard to need for intubation (p smaller than 0.511), pulmonary arterial pressures after extubation (p smaller than 0.817), and duration of chest drainage (p smaller than 0.650). Three patients died, one in the group deemed at high risk. There was no death in the last 38 patients.We conclude that a total cavopulmonary connection with an extracardiac tube can be performed without fenestration, even if the patients are deemed to be at increased risk. Early staging of patients with functionally univentricular physiology might be one of the keys for these findings.

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a study of the fontan circulation and ventricular energetics based on a model

Cardiology in the Young ◽

10.1017/s1047951104006493 ◽

2004 ◽

Vol 14 (S3) ◽

pp. 11-19 ◽

Cited By ~ 4

Author(s):

andrea ripoli ◽

sergio berti ◽

mattia glauber ◽

vittorio vanini ◽

vincenzo stefano luisi ◽

...

Keyword(s):

Single Ventricle ◽

Volume Overload ◽

Systemic Circulation ◽

Fontan Circulation ◽

Total Cavopulmonary Connection ◽

Right Heart ◽

Cavopulmonary Anastomosis ◽

Bidirectional Cavopulmonary Anastomosis ◽

The Right ◽

Cavopulmonary Connection

patients with congenitally malformed hearts characterised by a functionally single ventricle are currently treated using several procedures that bypass the right heart, such as the fontan and hemi-fontan operations, the bidirectional cavopulmonary anastomosis, and the total cavopulmonary connection. all these options are based on the procedures introduced for palliative correction of tricuspid atresia by fontan and baudet in 1971. introduced with the purpose of reducing the pre-operative volume overload, the surgical task mainly consists of separating the pulmonary from the systemic circulation. irrespective of the specific operation performed, we can call the resulting circulation the fontan circulation.

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Efficacy of bubble contrast echocardiography in detecting pulmonary arteriovenous fistulas in children with univentricular heart after total cavopulmonary connection

Cardiology in the Young ◽

10.1017/s104795111900324x ◽

2020 ◽

Vol 30 (2) ◽

pp. 227-230

Author(s):

Dai Asada ◽

Yuma Morishita ◽

Yoko Kawai ◽

Yo Kajiyama ◽

Kazuyuki Ikeda

Keyword(s):

False Positive ◽

Contrast Echocardiography ◽

Pulmonary Arteries ◽

Total Cavopulmonary Connection ◽

Arteriovenous Fistulas ◽

Pulmonary Capillary ◽

Cavopulmonary Anastomosis ◽

Positive Results ◽

Cavopulmonary Connection ◽

Pulmonary Arteriovenous Fistulas

AbstractBackground:Development of pulmonary arteriovenous fistulas in patients with cavopulmonary anastomosis may result in a significant morbidity. Although the use of bubble contrast echocardiography with selective injection into both the branch pulmonary arteries in identifying pulmonary arteriovenous fistulas has been increasing, the actual efficacy of this diagnostic modality has not been properly evaluated. Thus, this study aimed to assess the efficacy of bubble contrast echocardiography in detecting pulmonary arteriovenous fistulas in children with total cavopulmonary connection.Methods:A total of 140 patients were included. All patients underwent cardiac catheterisation. Bubble contrast echocardiographic studies were performed by injecting agitated saline solution into the branch pulmonary arteries. Transthoracic echocardiograms that use an apical view were conducted to assess the appearance of bubble contrast in the systemic ventricles. Then, the contrast echocardiogram results and other cardiac parameters were compared.Results:No correlation was found between contrast echocardiogram grade and other cardiac parameters, such as pulmonary capillary wedge saturation and pulmonary artery resistance. Moreover, only 13 patients had negative results on both the right and left contrast echocardiograms, and 127 of the 140 patients had positive results on contrast echocardiograms even though they had normal pulmonary capillary wedge saturation. Results showed that bubble contrast echocardiography was a highly sensitive method and was likely to obtain false-positive results.Conclusions:Bubble contrast echocardiography might be highly false positive in detecting pulmonary arteriovenous fistulas in patients with cavopulmonary anastomosis. We have to consider how we make use of this method. Further standardisation of techniques is required.

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Cardiac performance and quality of life in patients who have undergone the Fontan procedure with and without prior superior cavopulmonary connection

Cardiology in the Young ◽

10.1017/s1047951112001175 ◽

2012 ◽

Vol 23 (3) ◽

pp. 335-343 ◽

Cited By ~ 9

Author(s):

Andrew M. Atz ◽

Thomas G. Travison ◽

Brian W. McCrindle ◽

Lynn Mahony ◽

Andrew C. Glatz ◽

...

Keyword(s):

Fontan Procedure ◽

Cross Sectional Study ◽

Univentricular Heart ◽

P Value ◽

Cross Sectional ◽

Ventricular Performance ◽

Cavopulmonary Anastomosis ◽

Bidirectional Cavopulmonary Anastomosis ◽

Fontan Surgery ◽

Cavopulmonary Connection

AbstractBackgroundA superior cavopulmonary connection is commonly performed before the Fontan procedure in patients with a functionally univentricular heart. Data are limited regarding associations between a prior superior cavopulmonary connection and functional and ventricular performance late after the Fontan procedure.MethodsWe compared characteristics of those with and without prior superior cavopulmonary connection among 546 subjects enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study. We further compared different superior cavopulmonary connection techniques: bidirectional cavopulmonary anastomosis (n equals 229), bilateral bidirectional cavopulmonary anastomosis (n equals 39), and hemi-Fontan (n equals 114).ResultsA prior superior cavopulmonary connection was performed in 408 subjects (75%); the proportion differed by year of Fontan surgery and centre (p-value less than 0.0001 for each). The average age at Fontan was similar, 3.5 years in those with superior cavopulmonary connection versus 3.2 years in those without (p-value equals 0.4). The type of superior cavopulmonary connection varied by site (p-value less than 0.001) and was related to the type of Fontan procedure. Exercise performance, echocardiographic variables, and predominant rhythm did not differ by superior cavopulmonary connection status or among superior cavopulmonary connection types. Using a test of interaction, findings did not vary according to an underlying diagnosis of hypoplastic left heart syndrome.ConclusionsAfter controlling for subject and era factors, most long-term outcomes in subjects with a prior superior cavopulmonary connection did not differ substantially from those without this procedure. The type of superior cavopulmonary connection varied significantly by centre, but late outcomes were similar.

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Increase in N-Terminus-Pro-B-Type Natriuretic Peptide During Exercise of Patients With Univentricular Heart After a Total Cavopulmonary Connection

Pediatric Cardiology ◽

10.1007/s00246-012-0210-2 ◽

2012 ◽

Vol 33 (5) ◽

pp. 764-769 ◽

Cited By ~ 8

Author(s):

Alfred Hager ◽

Florian Christov ◽

John Hess

Keyword(s):

Natriuretic Peptide ◽

Univentricular Heart ◽

Total Cavopulmonary Connection ◽

N Terminus ◽

Cavopulmonary Connection

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Brain natriuretic peptide assessed at long-term follow-up before and after maximal exercise in surgically palliated patients with functionally univentricular hearts

Cardiology in the Young ◽

10.1017/s1047951107000686 ◽

2007 ◽

Vol 17 (5) ◽

pp. 505-511 ◽

Cited By ~ 6

Author(s):

Daniel Holmgren ◽

Eva Strömvall-Larsson ◽

Per-Arne Lundberg ◽

Bengt O. Eriksson ◽

Håkan Wåhlander

Keyword(s):

Brain Natriuretic Peptide ◽

Ventricular Function ◽

Natriuretic Peptide ◽

Maximal Exercise ◽

Fontan Procedure ◽

Control Group ◽

Total Cavopulmonary Connection ◽

Before And After ◽

Long Term Follow Up ◽

Cavopulmonary Connection

AbstractWe evaluated the concentrations of brain natriuretic peptide in the plasma as a marker of systolic ventricular function before and after maximal exercise in 15 surgically palliated patients with functionally univentricular hearts, with apparently good ventricular function. Of the patients, 6 with median age of 14.6 years, and a range from 12.5 to 17.9 years, had been palliated by construction of a total cavopulmonary connection, while the other 9 patients, with a median age of 32.1 years, and a range from 15.6 to 54.2 years, had undergone the classical Fontan procedure. We used 8 healthy individuals, with a median age of 13.9 years, and a range from 12.8 to 14.2 years, as a control group for the measurements of brain natriuretic peptide. The values of the peptide were significantly higher in those with the classical Fontan procedure, both before, when the median value was 131.8 nanogram per litre, with a range from 0.5 to 296.4, and after maximal exercise, when the median value was 108.1, with a range from 0.1 to 235.9. The comparable values in those with a total cavopulmonary connection were a median of 12.8, and a range from 0.5 to 39.1 before, and a median of 9.7, with a range from 2.7 to 26.2 after maximal exercise. The median value for the control group was 13.1, with a range from 2.6 to 38.7 before exercise (p = 0.016), and a median of 24.1, with a range from 5.8 to 66.7 after maximal exercise (p = 0.03), respectively. In the control subjects, the level of the peptide increased by a median of 9.7 nanograms per litre, with a range from 1.2 to 28.0 after maximal exercise (p = 0.008). The level was unchanged after maximal exercise in those with classical Fontan procedures and total cavopulmonary connections, with a difference between levels before and after exercise of a median of 5.9 nanogram per litre, and a range from −23.7 to 31.0 (p = 0.96), and a median of −1.0 nanogram per litre, with a range from −12.0 to 3.9 (p > 0.99), respectively. We conclude that maximal exercise did not increase the level of brain natriuretic peptide level in those patients with the classical Fontan procedure, nor those with a total cavopulmonary connection, findings which may indicate that systolic ventricular dysfunction is not the major cause of the decreased working capacity observed in patients with well functioning palliated functionally univentricular hearts.

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B-type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

European Journal of Heart Failure ◽

10.1016/j.ejheart.2007.11.001 ◽

2008 ◽

Vol 10 (1) ◽

pp. 60-62 ◽

Cited By ~ 40

Author(s):

Andreas M.E. Koch ◽

Stefan Zink ◽

Helmut Singer ◽

Sven Dittrich

Keyword(s):

Natriuretic Peptide ◽

Total Cavopulmonary Connection ◽

Cavopulmonary Connection

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Use of an Amplatzer ductal occluder to close a persistent left superior caval vein which reopened after a total cavopulmonary anastomosis

Cardiology in the Young ◽

10.1017/s1047951102000173 ◽

2002 ◽

Vol 12 (1) ◽

pp. 81-83 ◽

Cited By ~ 4

Author(s):

Marie-Christine Seghaye ◽

Uwe Wainwright ◽

Götz von Bernuth

Keyword(s):

Total Cavopulmonary Connection ◽

Caval Vein ◽

Superior Caval Vein ◽

Large Size ◽

Cavopulmonary Anastomosis ◽

Cavopulmonary Connection ◽

Total Cavopulmonary Anastomosis

A 7-year-old boy developed increasing cyanosis after a total cavopulmonary connection with a 3mm fenestration in the baffle. Catheterisation performed 4 years and 7 months after the operation showed reopening of a left superior caval vein draining into the pulmonary venous atrium. Due to the large size of the left superior caval vein, and the absence of intrinsic stenosis, we chose to use an Amplatzer ductal device to occlude the reopened vein. The procedure was safe and successful.

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