Changes in pulmonary artery size before and after 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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Off-Pump Total Cavopulmonary Connection in a Patient with Hypoplastic Right Pulmonary Artery and Right Lung Secondary to Kyphoscoliosis

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.2007.00541.x ◽

2008 ◽

Vol 23 (5) ◽

pp. 565-568 ◽

Cited By ~ 3

Author(s):

Murat Ugurlucan ◽

Kemal Nisli ◽

Emin Tireli ◽

Enver Dayioglu

Keyword(s):

Pulmonary Artery ◽

Total Cavopulmonary Connection ◽

Off Pump ◽

Right Pulmonary Artery ◽

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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Noninvasive Assessment of Pulmonary Artery Pressure in Patients with Extracardiac Conduit Total Cavopulmonary Connection

Pediatric Cardiology ◽

10.1007/s00246-016-1442-3 ◽

2016 ◽

Vol 37 (7) ◽

pp. 1361-1369

Author(s):

Gholam hossein Ajami ◽

Hamid Mohammadi ◽

Ahmad Ali Amirghofran ◽

Mohammad Borzouee ◽

Hamid Amoozgar ◽

...

Keyword(s):

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Total Cavopulmonary Connection ◽

Artery Pressure ◽

Extracardiac Conduit ◽

Noninvasive Assessment ◽

Cavopulmonary Connection

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Traditional Atriopulmonary Connection Fontan with Excellent Outcome for 32 Years

The Thoracic and Cardiovascular Surgeon Reports ◽

10.1055/s-0040-1708528 ◽

2020 ◽

Vol 09 (01) ◽

pp. e18-e20

Author(s):

Yong Zhang ◽

Minhua Fang ◽

Zengwei Wang ◽

Huishan Wang

Keyword(s):

Pulmonary Artery ◽

Electroconvulsive Therapy ◽

Surgical Procedure ◽

Pulmonary Stenosis ◽

Right Atrial ◽

Total Cavopulmonary Connection ◽

Transposition Of Great Arteries ◽

Excellent Outcome ◽

Cavopulmonary Connection ◽

Fontan Patients

AbstractAlthough the traditional right atrial–pulmonary artery (RA–PA) Fontan has been replaced by the total cavopulmonary connection, some RA–PA Fontan patients still have good outcome. We report a 37-year-old male who underwent traditional Fontan 32 years ago with the diagnosis of L-transposition of great arteries, subvalvular pulmonary stenosis and cardiac dextroversion. Among the recent CTA, electroconvulsive therapy, catheterization and angiography, pulsatile PA, uniform pulmonary blood, normal PA pressure and resistance were observed in this patient. The traditional RA–PA Fontan may be an alternative surgical procedure.

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Comparison of Particle Image Velocimetry and Phase Contrast MRI in a Patient-Specific Extracardiac Total Cavopulmonary Connection

Journal of Biomechanical Engineering ◽

10.1115/1.2900725 ◽

2008 ◽

Vol 130 (4) ◽

Cited By ~ 19

Author(s):

Hiroumi D. Kitajima ◽

Kartik S. Sundareswaran ◽

Thomas Z. Teisseyre ◽

Garrett W. Astary ◽

W. James Parks ◽

...

Keyword(s):

Particle Image Velocimetry ◽

Pulmonary Artery ◽

Phase Contrast ◽

Particle Image ◽

Vena Cava ◽

Patient Specific ◽

Flow Structures ◽

Total Cavopulmonary Connection ◽

Image Velocimetry ◽

Cavopulmonary Connection

Particle image velocimetry (PIV) and phase contrast magnetic resonance imaging (PC-MRI) have not been compared in complex biofluid environments. Such analysis is particularly useful to investigate flow structures in the correction of single ventricle congenital heart defects, where fluid dynamic efficiency is essential. A stereolithographic replica of an extracardiac total cavopulmonary connection (TCPC) is studied using PIV and PC-MRI in a steady flow loop. Volumetric two-component PIV is compared to volumetric three-component PC-MRI at various flow conditions. Similar flow structures are observed in both PIV and PC-MRI, where smooth flow dominates the extracardiac TCPC, and superior vena cava flow is preferential to the right pulmonary artery, while inferior vena cava flow is preferential to the left pulmonary artery. Where three-component velocity is available in PC-MRI studies, some helical flow in the extracardiac TCPC is observed. Vessel cross sections provide an effective means of validation for both experiments, and velocity magnitudes are of the same order. The results highlight similarities to validate flow in a complex patient-specific extracardiac TCPC. Additional information obtained by velocity in three components further describes the complexity of the flow in anatomic structures.

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