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

1998 ◽  
Vol 8 (3) ◽  
pp. 358-363 ◽  
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.

Pulmonary blood flow distribution after the total cavopulmonary connection for complex cardiac anomalies

1999 ◽  
Vol 14 (3) ◽  
pp. 154-160 ◽  
Author(s):  
Masao Tayama ◽  
Nobuaki Hirata ◽  
Tohru Matsushita ◽  
Tetsuya Sano ◽  
Norihide Fukushima ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Flow Distribution ◽  
Total Cavopulmonary Connection ◽  
Blood Flow Distribution ◽  
Cardiac Anomalies ◽  
Cavopulmonary Connection

Efficacy of very low-dose prostaglandin E1 in duct-dependent congenital heart disease

2013 ◽  
Vol 25 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Ilker K. Yucel ◽  
Ayhan Cevik ◽  
Mustafa O. Bulut ◽  
Reyhan Dedeoğlu ◽  
İbrahim H. Demir ◽  
...  
Keyword(s):  
Blood Flow ◽  
Treatment Duration ◽  
Pulmonary Blood Flow ◽  
Prostaglandin E1 ◽  
Low Dose ◽  
Ductus Arteriosus ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Group 2 ◽  
Group 1

AbstractAimThe present study aims to define the lowest effective prostaglandin E1 dose in patients with inadequacy of pulmonary blood flow and/or intracardiac blood mixing and those with inadequate systemic blood flow.MethodsPatients with inadequacy of both pulmonary blood flow and/or blood mixing (Group 1) and those with inadequate systemic blood flow (Group 2) were retrospectively evaluated in two separate groups with regard to the prostaglandin E1 starting dose given in the referring facility, the lowest and the highest dose administered in our centre, treatment duration, adverse effects, and administered treatment.ResultsNo difference between the groups could be detected with respect to sex or birth weight (p=0.95 and 0.42, respectively). Group 1 and Group 2 were statistically similar in aspect of prostaglandin treatment duration (9.73±0.81 days versus 11.6±1.05 days, p=0.064). When compared with Group 2, the initial, maintenance and lowest efficient doses of prostaglandin E1 treatment were significantly lower and the titrated dose of prostaglandin E1 was significantly higher in Group 1 (p=0.001 for each).ConclusionOur findings indicate that the infusion of prostaglandin at a very low dose (0.003–0.005 mcg/kg/minute) is sufficient to maintain the patency of the ductus arteriosus. A higher dose of prostaglandin E1 may be necessary in patients with inadequate systemic blood flow.

Effects of Anoxia on Pulmonary Circulation: Reflex Pulmonary Vasoconstriction

1957 ◽  
Vol 189 (2) ◽  
pp. 253-262 ◽  
Author(s):  
Domingo M. Aviado ◽  
Johnson S. Ling ◽  
Carl F. Schmidt
Keyword(s):  
Blood Flow ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Pulmonary Blood Flow ◽  
Arterial Oxygen Saturation ◽  
Nerve Fibers ◽  
Reflex Response ◽  
Arterial Oxygen ◽  
Pulmonary Vasoconstriction ◽  
Lung Vessels

The inhalation of 5 or 10% oxygen in anesthetized dogs causes increased pulmonary arterial pressure, increased pulmonary blood flow (measured directly by cannulalation of one lobar vein) but increased or decreased pulmonary vascular resistance. At least four opposing factors are responsible for the variable effects of anoxia on vascular resistance, namely: a) reflex pulmonary vasoconstriction from anoxic stimulation of chemoreceptors in the carotid and aortic bodies (demonstrable in innervated lobe that is perfused and ventilated independently of all other lobes); b) local pulmonary vasodilatation (brought about by reduction in oxygen content of the air ventilating or of the blood perfusing the lobe); c) passive reduction in pulmonary vascular resistance secondary to anoxic increase of pulmonary blood flow; and d) liberation of epinephrine capable of stimulating the heart and constricting the lung vessels. The reflex pulmonary vasoconstriction can be demonstrated only if the perivascular nerve fibers are preserved. This reflex response is mediated by the thoracic sympathetics and is activated by less severe anoxemia (reduction of arterial oxygen saturation by at least 10%) as compared to the other mechanisms (local and passive dilatation which require reduction of saturation by at least 30%).

Distribution of pulmonary and bronchial blood supply to airways measured by fluorescent microspheres

1996 ◽  
Vol 80 (2) ◽  
pp. 430-436 ◽  
Author(s):  
S. L. Bernard ◽  
R. W. Glenny ◽  
N. L. Polissar ◽  
D. L. Luchtel ◽  
S. Lakshminarayan
Keyword(s):  
Blood Flow ◽  
Blood Supply ◽  
Pulmonary Blood Flow ◽  
Left Lung ◽  
Vena Cava ◽  
Fluorescent Microspheres ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Tissue Volume ◽  
Airway Walls

This study determined the relative contributions of systemic (bronchial) and pulmonary blood flow to the intraparenchymal airways =1 mm in diameter by using 15-mu m fluorescent microspheres and fluorescence microscopy in four dogs. Fluorescent microspheres of one color were injected into the inferior vena cava as a pulmonary blood flow marker, and fluorescent microspheres of another color were injected into the left ventricle as a systemic blood flow marker. After the second injection, the animals were killed and the lungs were excised and air dried at total lung capacity. The left lung was sliced into transverse planes and then sectioned into smaller blocks containing airways down to 1 mm in diameter. The blocks were then sectioned using a Vibratome and examined with a fluorescence microscope. Pulmonary and systemic blood flow markers were counted in airway walls, and the diameter of each airway was measured to determine the bronchial tissue volume. After a correction for the number of blood flow markers injected into each circulation, the average ratio of pulmonary to systemic blood flow markers seen in airway walls was 1:37, indicating that 97% of the blood supply to the intraparenchymal airways down to 1 mm in diameter was from the bronchial circulation. Furthermore, on the basis of a weighted least squares regression analysis, systemic (bronchial) blood flow per unit tissue volume increased as airway diameter decreased (P = 0.03).

Recanalisation of the left superior caval vein after Fontan procedure: not so rare complication: possibilities of percutaneous closure using various devices

2014 ◽  
Vol 25 (3) ◽  
pp. 485-490
Author(s):  
Jacek Kusa ◽  
Leslaw Szydlowski ◽  
Ewa Nowakowska ◽  
Agnieszka Skierska
Keyword(s):  
Rare Complication ◽  
Fontan Procedure ◽  
Arterial Oxygen Saturation ◽  
Percutaneous Closure ◽  
Arterial Oxygen ◽  
Total Cavopulmonary Connection ◽  
Sudden Increase ◽  
Caval Vein ◽  
Superior Caval Vein ◽  
Cavopulmonary Connection

AbstractAim: Evaluation of possibilities of percutaneous closure of recanalised left superior caval vein after total cavopulmonary connection.Methods and Results: We analysed 19 patients after total cavopulmonary connection catheterised because of a sudden increase of desaturation. In four of them, the recanalisation of the left superior caval vein was identified. For this reason, the balloon occlusion tests of the veins were made temporarily. In all cases, the haemodynamic status of patients did not change, and arterial oxygen saturation increased significantly. Thus, using different types of implants, these veins were closed effectively in all patients. During the short-term follow-up, the effectiveness of treatments and constantly maintaining a high level of saturation were confirmed.Conclusions: Meticulous investigation of unclear causes of desaturation in cyanotic patients after Fontan completion is necessary. Almost all causes of desaturation, including recanalised additional left superior caval vein, can be effectively treated percutaneously.

scholarly journals Interstage management of pulmonary blood flow after the Norwood procedure with right ventricle-to-pulmonary artery conduit

2020 ◽  
Vol 58 (3) ◽  
pp. 551-558
Author(s):  
Takashi Yasukawa ◽  
Takaya Hoashi ◽  
Masataka Kitano ◽  
Masatoshi Shimada ◽  
Kenta Imai ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Artery ◽  
Pulmonary Blood Flow ◽  
Norwood Procedure ◽  
Flow Ratio ◽  
Hypoplastic Left Heart ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Blood Flow Ratio ◽  
Left Heart Syndrome

Abstract OBJECTIVES Our goal was to assess the efficacy of managing pulmonary blood flow from the Norwood procedure with a right ventricle-to-pulmonary artery (RV–PA) conduit until stage 2 palliation (S2P). METHODS Among 48 consecutive patients undergoing the Norwood procedure between 2008 and 2018, 40 (83.3%) patients who survived to discharge were included in this study. The primary diagnosis was hypoplastic left heart syndrome in 28 (70%) patients and hypoplastic left heart syndrome variant in 12 (30%) patients. All patients received bilateral pulmonary artery banding. The median age and weight at the time of the Norwood procedure were 41 (25th–75th percentiles: 27–89) days and 3.2 (2.7–3.9) kg, respectively. In keeping with institutional strategy, S2P was undertaken when body weight exceeded 5.0 kg, and normal gross motor development was confirmed. RESULTS The RV–PA conduit was clipped in 28 (70%) patients during the perioperative period of the Norwood procedure, then partial unclipping was performed in 8 (20%) patients and full unclipping was performed in 20 (50%) patients. Before S2P, the median pulmonary-to-systemic blood flow ratio was 1.0 (0.7–1.3). The median age and weight at the time of S2P were 10.7 (9.0–12.9) months and 6.3 (5.5–7.1) kg, respectively. The survival rate 5 years after Norwood discharge was 85.3%. Pre-S2P pulmonary-to-systemic blood flow ratio was linearly correlated with greater interstage changes in systemic atrioventricular valve regurgitation (R2 = 0.223, P = 0.004). CONCLUSIONS Interstage management of pulmonary blood flow by RV–PA conduit clipping and gradual unclipping provided good interstage outcomes. The median pulmonary-to-systemic blood flow ratio could be controlled to 1.0 at pre-S2P catheter examination.

The Effect of Additional Pulmonary Blood Flow on Timing of the Total Cavopulmonary Connection

2012 ◽  
Vol 93 (6) ◽  
pp. 2028-2033 ◽  
Author(s):  
Ymkje J. van Slooten ◽  
Nynke J. Elzenga ◽  
Tjalling W. Waterbolk ◽  
Joost P. van Melle ◽  
Rolf M.F. Berger ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Total Cavopulmonary Connection ◽  
Cavopulmonary Connection
Sign in / Sign up

Export Citation Format

Share Document