The impact of additional antegrade pulmonary blood flow at bidirectional Glenn shunt on long-term outcomes

2021 ◽  
Author(s):  
Jae Suk Baek ◽  
Chun Soo Park ◽  
Eun Seok Choi ◽  
Tae-Jin Yun ◽  
Bo Sang Kwon ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Long Term Outcomes ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Bidirectional Glenn Shunt ◽  
The Impact

CFD Modeling of Blood Flow in a Bidirectional Glenn Shunt and a Combined Bidirectional Glenn and Blalock-Taussig Shunt

2021 ◽  
Author(s):  
Chunhui Wang ◽  
Ramesh K. Agarwal
Keyword(s):  
Blood Flow ◽  
Shear Stress ◽  
Wall Shear Stress ◽  
Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Patient Specific ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Bidirectional Glenn Shunt ◽  
Blalock Taussig Shunt

Abstract Cyanosis or “Blue Baby Syndrome,” is an infant disorder which affects the newly born babies whose skins turn blue or purple because of lack of required blood flow between heart and lung due to pulmonary vascular blockage. Many patients may also have stenosis in vessels. If there is not enough blood flow from heart to the lung, lack of oxygen will cause platelet aggregation and coagulation resulting in elevated wall shear stress which may potentially result in death. In order to address the congenital defect and increase blood flow and oxygen saturation levels within the blood pumping system, a biological shunt is usually planted between innominate veins and left and right pulmonary arteries. The well-known examples are Blalock-Taussig shunt (BT shunt) between right ventricle and pulmonary artery and bidirectional Glenn shunt (BGS) between innominate veins and pulmonary arteries. The goal of this paper is to study the hemodynamics of BGS, wherein the blood flow goes through superior vena cava (SVC), innominate and subclavian veins and pulmonary arteries. In another simulation, Blalok-Taussing shunt (BTS) is also included along with the BGS. In BTS, the blood directly flows between innominate and pulmonary artery. The models are created with SolidWorks and Blender software based on real patient aorta model parameters. The commercial CFD software ANSYS is used to simulate the blood flow. CFD simulations are performed for blood flow (1) in patient specific aorta model without BGS and (2) in patient specific model with both BGS and BTS. The results for distribution of pressure, velocity and wall shear stress are obtained and analyzed to evaluate the performance of BGS alone and with both BGS and BTS. The computations are compared with limited available clinical data. This study demonstrates how CFD can be effectively utilized in the design of medical devices such as BGS and BTS and to improve the clinical outcomes in patients.

Abstract 17326: The Effect of Maintenance of Antegrade Pulmonary Blood Flow Upon Bidirectional Glenn on Pre- and Post-Fontan Outcomes

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Jae Suk Baek ◽  
Chun Soo Park ◽  
Eun Seok Choi ◽  
Bo Sang Kwon ◽  
Tae-Jin Yun ◽  
...  
Keyword(s):  
Blood Flow ◽  
Oxygen Saturation ◽  
Pulmonary Blood Flow ◽  
Fontan Operation ◽  
Advantages And Disadvantages ◽  
Bidirectional Glenn ◽  
Pulmonary Arterial ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Introduction: Maintaining pulsatility at the time of bidirectional Glenn (BDG) has theoretical advantages and disadvantages. The practice is diverse throughout the centers and individual surgeons without clear rationale behind its application. We sought to investigate the impact of antegrade pulmonary blood flow on pre- and post-Fontan outcomes. Methods: From 2003 through June 2014, among 237 patients who underwent BDG as an interim palliation for functional single ventricle (FSV), patients with preexisting pulmonary blood flow from the ventricle before BDG were included and patients undergoing Kawashima operation or having history of Norwood operation or bilateral pulmonary arterial band were excluded (n=151). Patients were grouped by their presence or absence of antegrade pulmonary blood flow following BDG: group 1 (pulsatile) (n=73) or group 2 (non-pulsatile) (n=78). The pre- and post-Fontan outcomes were compared between two groups. Results: Age and weight at BDG were 7 months and 7.8kg. Oxygen saturation was higher in group 1 (84±4%) compared to group 2 (82±4%) before Fontan (p<0.001). The level of brain natriuretic peptide (BNP) was similar before Fontan (p=0.966). In pre-Fontan cardiac catheterization, mean pulmonary arterial pressure was similar (Group 1: 11±4mmHg vs. Group 2: 10±4mmHg, p=0.146), McGoon ratio seemed higher in group 1(2.6±0.6) compared to group 2(2.3±0.4) (p=0.057), and pulmonary vascular resistance was lower in group 1(1.3±0.7) compared to group 2(1.6±0.7)(p=0.038). A total of 136 patients (90%) underwent Fontan operation. Duration of stay in the intensive care unit (p=0.766), stay in hospital (p=0.142), and indwelling chest tube (p=0.128) was not different between groups. Overall survival after BDG was better in group 2 (p=0.046) [Figure]. In multivariable analysis, maintenance of pulsatility was identified as a risk factor for survival after BDG (p=0.012, HR 4.1 [CI 1.4-12.4]). Conclusions: Maintaining pulsatility at the time of BDG in FSV might be beneficial for pulmonary arterial growth and oxygen saturation without increasing BNP. However, such beneficial effect did not have a positive effect on subsequent Fontan outcome. Attention must be paid to the negative effect of pulsatility on overall post-BDG survival.

Examining the Impact of the Disabled Youth Peer Development Initiative: What are the Long-Term Outcomes?

2003 ◽  
Author(s):  
Teresa Garate-Serafini ◽  
Jose Mendez ◽  
Patty Arriaga ◽  
Larry Labiak ◽  
Carol Reynolds
Keyword(s):  
Long Term Outcomes ◽  
The Disabled ◽  
The Impact

scholarly journals Impact of established cardiovascular disease on 10-year death after coronary revascularization for complex coronary artery disease

2021 ◽  
Author(s):  
Rutao Wang ◽  
Scot Garg ◽  
Chao Gao ◽  
Hideyuki Kawashima ◽  
Masafumi Ono ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Revascularization ◽  
Long Term Outcomes ◽  
Vital Status ◽  
Increased Risk ◽  
Artery Disease ◽  
The Impact

Abstract Aims To investigate the impact of established cardiovascular disease (CVD) on 10-year all-cause death following coronary revascularization in patients with complex coronary artery disease (CAD). Methods The SYNTAXES study assessed vital status out to 10 years of patients with complex CAD enrolled in the SYNTAX trial. The relative efficacy of PCI versus CABG in terms of 10-year all-cause death was assessed according to co-existing CVD. Results Established CVD status was recorded in 1771 (98.3%) patients, of whom 827 (46.7%) had established CVD. Compared to those without CVD, patients with CVD had a significantly higher risk of 10-year all-cause death (31.4% vs. 21.7%; adjusted HR: 1.40; 95% CI 1.08–1.80, p = 0.010). In patients with CVD, PCI had a non-significant numerically higher risk of 10-year all-cause death compared with CABG (35.9% vs. 27.2%; adjusted HR: 1.14; 95% CI 0.83–1.58, p = 0.412). The relative treatment effects of PCI versus CABG on 10-year all-cause death in patients with complex CAD were similar irrespective of the presence of CVD (p-interaction = 0.986). Only those patients with CVD in ≥ 2 territories had a higher risk of 10-year all-cause death (adjusted HR: 2.99, 95% CI 2.11–4.23, p < 0.001) compared to those without CVD. Conclusions The presence of CVD involving more than one territory was associated with a significantly increased risk of 10-year all-cause death, which was non-significantly higher in complex CAD patients treated with PCI compared with CABG. Acceptable long-term outcomes were observed, suggesting that patients with established CVD should not be precluded from undergoing invasive angiography or revascularization. Trial registration SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract

scholarly journals Neuroimaging at Term Equivalent Age: Is There Value for the Preterm Infant? A Narrative Summary

Children ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 227
Author(s):  
Rudaina Banihani ◽  
Judy Seesahai ◽  
Elizabeth Asztalos ◽  
Paige Terrien Church
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Preterm Infant ◽  
Resonance Imaging ◽  
Long Term Outcomes ◽  
Equivalent Age ◽  
Current State ◽  
Patterns Of Injury ◽  
The Impact

Advances in neuroimaging of the preterm infant have enhanced the ability to detect brain injury. This added information has been a blessing and a curse. Neuroimaging, particularly with magnetic resonance imaging, has provided greater insight into the patterns of injury and specific vulnerabilities. It has also provided a better understanding of the microscopic and functional impacts of subtle and significant injuries. While the ability to detect injury is important and irresistible, the evidence for how these injuries link to specific long-term outcomes is less clear. In addition, the impact on parents can be profound. This narrative summary will review the history and current state of brain imaging, focusing on magnetic resonance imaging in the preterm population and the current state of the evidence for how these patterns relate to long-term outcomes.

Novel techniques of bidirectional Glenn shunt without cardiopulmonary bypass

1999 ◽  
Vol 67 (6) ◽  
pp. 1771-1774 ◽  
Author(s):  
Kona Samba Murthy ◽  
Robert Coelho ◽  
Shivaprakasha K Naik ◽  
Anil Punnoose ◽  
Wilson Thomas ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Bidirectional Glenn Shunt

Successful surgical repair of Uhl's anomaly

2002 ◽  
Vol 12 (2) ◽  
pp. 192-195 ◽  
Author(s):  
Nawal Azhari ◽  
Mervat Assaqqat ◽  
Ziad Bulbul
Keyword(s):  
Right Ventricle ◽  
Surgical Repair ◽  
Total Cavopulmonary Connection ◽  
Thromboembolic Stroke ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Bidirectional Glenn Shunt ◽  
Patch Closure ◽  
The Right ◽  
Cavopulmonary Connection

We report a case of Uhl's anomaly in a 5-month-old cyanotic infant who presented with thromboembolic stroke and acute hemiparesis. The patient underwent successfully an initial surgical repair, which included exclusion of the right ventricle by patch closure of the tricuspid valve, atrial septectomy and construction of a bidirectional Glenn shunt. This was followed by successful construction of a total cavopulmonary connection.

The impact of myosteatosis on outcomes following surgery for gastro-intestinal malignancy: A systematic review and meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e15540-e15540
Author(s):  
Andrew MacCormick ◽  
Mark Puckett ◽  
Adam Streeter ◽  
Somaiah Aroori
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Group Analysis ◽  
Long Term Outcomes ◽  
Cancer Specific Survival ◽  
Mesh Terms ◽  
Similar Term ◽  
Colorectal Cancer Patients ◽  
The Impact

e15540 Background: Recent research has demonstrated the impact that body composition parameters can have on the outcomes following cancer surgery. Adipose tissue deposition in muscle, known as myosteatosis, can be detected on pre-operative imaging. This systematic review aims to analyse the impact of pre-operative myosteatosis on long-term outcomes following surgery for gastro-intestinal malignancy. Methods: Using MeSH terms, a systematic search of the databases PubMed MEDLINE, EMBASE, Cochrane, CINAHL and AMED was performed. Studies were included if they reported hazard ratios (HR) analysing the impact of pre-operatively defined myosteatosis, or similar term, on the long-term outcomes following surgery for gastro-intestinal malignancy. A total of 39 full texts articles were reviewed for inclusion, with 19 being included after the inclusion criteria were applied. A sub-group analysis was performed for those studies reporting outcomes for colorectal cancer patients only. Results: The total number of included patients across all studies was 14,481. Patients with myosteatosis had a significantly poorer overall survival, according to univariate (HR 1.82, 95% CI 1.67 – 1.99) and multivariable (HR 1.66, 95% CI 1.49 – 1.86) analysis. This was also demonstrated with regards to cancer-specific survival (univariate HR 1.62, 95% CI 1.18 – 2.22, multivariable HR 1.73, 95% CI 1.48 – 2.03) and recurrence-free survival (univariate HR 1.28, 95% CI 1.10 – 1.48, multivariable HR 1.38, 95% CI 1.07 – 1.77). Conclusions: This review demonstrates that patients with pre-operative myosteatosis have poorer long-term outcomes following surgery for gastro-intestinal malignancy. Therefore, myosteatosis should be used for pre-operative optimisation and as a prognostic tool before surgery. More standardised definitions of myosteatosis and further cohort studies of patients with non-colorectal malignancies are required.

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