Use of the bidirectional cavopulmonary shunt in patients under one year of age

SummaryBetween January 1990 and March 1992, a bidirectional cavopulmonary shunt was performed in seven patients under one year of age for palliation of complex cyanotic congenital heart disease. Five cases had tricuspid atresia with a restrictive ventricular septal defect. One case presented with complete mirror imagery, right-sided heart, double inlet and double outlet right ventricle with pulmonary stenosis. Another case had isomerism of the left atrial appendages with common atrioventricular valve and double outlet right ventricle. All had a pulmonary arterial index greater than 250 mm/m2(Nakata index). Age and weights before surgery averaged five months (one to 11 months) and 5.6 kg (range 2.8 to 8.5 kg) respectively. Preoperative mean arterial oxygen saturation measured by cardiac catheterization was 60.05±14% and postoperative mean arterial oxygen saturation on room air was 79.85±6.03% (p<0.05). There were no deaths, although postoperative complications occurred in three patients, namely pleural effusion and pneumothorax. Mean follow-up was 10±4.2 months. The cardiothoracic ratio decreased in all cases. On subsequent echocardiographic studies with pulsed Doppler sampling, low velocity systolic-diastolic forward flow was registered in the pulmonary trunk. The velocity of flow increased clearly during inspiration. The bidirectional cavopulmonary shunt can be considered as primary palliation for complex cardiac malformations with restricted pulmonary flow independent of age and body weight.

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Increased systemic cardiac output improves arterial oxygen saturation in bidirectional cavopulmonary shunt

Heart and Vessels ◽

10.1007/s00380-013-0438-7 ◽

2013 ◽

Vol 30 (1) ◽

pp. 56-60

Author(s):

Norihiko Oka ◽

Kagami Miyaji ◽

Tadashi Kitamura ◽

Keiichi Itatani ◽

Takeshi Yoshii ◽

...

Keyword(s):

Cardiac Output ◽

Oxygen Saturation ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Bidirectional Cavopulmonary Shunt ◽

Cavopulmonary Shunt

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Combined construction of bidirectional cavopulmonary and aortopulmonary shunts as an intermediate stage in the repair of an 18-year-old high-risk Fontan candidate

Cardiology in the Young ◽

10.1017/s1047951100003334 ◽

1996 ◽

Vol 6 (1) ◽

pp. 91-93

Author(s):

Masaaki Yamagishi ◽

Hiromi Kurosawa ◽

Kazuhiro Hashimoto

Keyword(s):

High Risk ◽

Oxygen Saturation ◽

Fontan Procedure ◽

Arterial Oxygen Saturation ◽

Pulmonary Atresia ◽

Intermediate Stage ◽

Arterial Oxygen ◽

Stroke Work ◽

Combined Procedure ◽

Cavopulmonary Shunt

AbstractA combined procedure of a bilateral bidirectional cavopulmonary shunt and a central aortopulmonaiy shunt was performed on an 18-year-old boy with pulmonary atresia. Arterial oxygen saturation was elevated after the combined shunt, whereas the ventricular stroke work was reduced. Such a combined shunt is a useful alternative prior procedure which does not produce ventricular overload in older or higher-risk candidates for the Fontan procedure.

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Cardiovascular adjustments to acute hypoxemia superimposed on chronic hypoxemia in lambs

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1995.268.3.h974 ◽

1995 ◽

Vol 268 (3) ◽

pp. H974-H979

Author(s):

M. Dalinghaus ◽

J. W. Gratama ◽

W. G. Zijlstra ◽

J. R. Kuipers

Keyword(s):

Blood Flow ◽

Oxygen Saturation ◽

Oxygen Supply ◽

Pulmonary Stenosis ◽

Arterial Oxygen Saturation ◽

Cardiovascular Responses ◽

Arterial Oxygen ◽

Blood Flows ◽

Regional Blood Flows ◽

Chronic Hypoxemia

Cardiovascular responses to acute hypoxemia are in part mediated through adrenergic and chemoreceptor stimulation. In chronic hypoxemia the response to these stimuli may be blunted. Therefore, we determined whether the cardiovascular responses to acute hypoxemia superimposed on 3–4 wk of chronic hypoxemia were blunted in lambs with an experimental cardiac right-to-left shunt (combination of atrial septal defect and variable pulmonary stenosis). Cardiovascular variables and regional blood flows were determined during chronic hypoxemia and after acutely reducing the arterial oxygen saturation by increasing the cardiac right-to-left shunt. Arterial oxygen saturation decreased (65 +/- 7 to 40 +/- 7%, P < 0.001) and systemic blood flow increased (164 +/- 63 to 233 +/- 100 ml.min-1.kg-1, P < 0.01), maintaining systemic oxygen supply and oxygen uptake. Blood flow to the myocardium (P < 0.01), the adrenals (P < 0.05), and the brain (0.05 < P < 0.10) increased, and oxygen supply to these organs was maintained. Conversely, blood flow to the kidneys and the gastrointestinal tract was unaltered, so that oxygen supply to these organs was decreased. The responses to acute hypoxemia in chronically hypoxemic lambs were similar to those previously reported in normoxemic lambs. We conclude that the cardiovascular responses to acute hypoxemia in chronically hypoxemic lambs are not blunted.

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Accuracy of two pulse-oximetry measurements for INTELLiVENT-ASV in mechanically ventilated patients: a prospective observational study

Scientific Reports ◽

10.1038/s41598-021-88608-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shinshu Katayama ◽

Jun Shima ◽

Ken Tonai ◽

Kansuke Koyama ◽

Shin Nunomiya

Keyword(s):

Oxygen Saturation ◽

Pulse Oximetry ◽

Prospective Observational Study ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Arterial Blood Gas ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Arterial Blood ◽

Ventilated Patients

AbstractRecently, maintaining a certain oxygen saturation measured by pulse oximetry (SpO2) range in mechanically ventilated patients was recommended; attaching the INTELLiVENT-ASV to ventilators might be beneficial. We evaluated the SpO2 measurement accuracy of a Nihon Kohden and a Masimo monitor compared to actual arterial oxygen saturation (SaO2). SpO2 was simultaneously measured by a Nihon Kohden and Masimo monitor in patients consecutively admitted to a general intensive care unit and mechanically ventilated. Bland–Altman plots were used to compare measured SpO2 with actual SaO2. One hundred mechanically ventilated patients and 1497 arterial blood gas results were reviewed. Mean SaO2 values, Nihon Kohden SpO2 measurements, and Masimo SpO2 measurements were 95.7%, 96.4%, and 96.9%, respectively. The Nihon Kohden SpO2 measurements were less biased than Masimo measurements; their precision was not significantly different. Nihon Kohden and Masimo SpO2 measurements were not significantly different in the “SaO2 < 94%” group (P = 0.083). In the “94% ≤ SaO2 < 98%” and “SaO2 ≥ 98%” groups, there were significant differences between the Nihon Kohden and Masimo SpO2 measurements (P < 0.0001; P = 0.006; respectively). Therefore, when using automatically controlling oxygenation with INTELLiVENT-ASV in mechanically ventilated patients, the Nihon Kohden SpO2 sensor is preferable.Trial registration UMIN000027671. Registered 7 June 2017.

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Modelling the relationships between arterial oxygen saturation, exercise intensity and the level of aerobic performance in acute hypoxia

European Journal of Applied Physiology ◽

10.1007/s00421-021-04667-8 ◽

2021 ◽

Author(s):

Xavier Woorons ◽

Jean Paul Richalet

Keyword(s):

Oxygen Saturation ◽

Exercise Intensity ◽

Acute Hypoxia ◽

Arterial Oxygen Saturation ◽

Aerobic Performance ◽

Arterial Oxygen

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BIOCHEMICAL STUDIES ON SHOCK

Journal of Experimental Medicine ◽

10.1084/jem.79.1.9 ◽

1944 ◽

Vol 79 (1) ◽

pp. 9-22 ◽

Cited By ~ 26

Author(s):

Frank L. Engel ◽

Helen C. Harrison ◽

C. N. H. Long

Keyword(s):

Blood Pressure ◽

Amino Acids ◽

Oxygen Saturation ◽

Hepatic Artery ◽

Arterial Oxygen Saturation ◽

Amino Nitrogen ◽

Arterial Oxygen ◽

High Positive Correlation ◽

Peripheral Tissues ◽

Arterial Blood

1. In a series of rats subjected to hemorrhage and shock a high negative correlation was found between the portal and peripheral venous oxygen saturations and the arterial blood pressure on the one hand, and the blood amino nitrogen levels on the other, and a high positive correlation between the portal and the peripheral oxygen saturations and between each of these and the blood pressure. 2. In five cats subjected to hemorrhage and shock the rise in plasma amino nitrogen and the fall in peripheral and portal venous oxygen saturations were confirmed. Further it was shown that the hepatic vein oxygen saturation falls early in shock while the arterial oxygen saturation showed no alteration except terminally, when it may fall also. 3. Ligation of the hepatic artery in rats did not affect the liver's ability to deaminate amino acids. Hemorrhage in a series of hepatic artery ligated rats did not produce any greater rise in the blood amino nitrogen than a similar hemorrhage in normal rats. The hepatic artery probably cannot compensate to any degree for the decrease in portal blood flow in shock. 4. An operation was devised whereby the viscera and portal circulation of the rat were eliminated and the liver maintained only on its arterial circulation. The ability of such a liver to metabolize amino acids was found to be less than either the normal or the hepatic artery ligated liver and to have very little reserve. 5. On complete occlusion of the circulation to the rat liver this organ was found to resist anoxia up to 45 minutes. With further anoxia irreversible damage to this organ's ability to handle amino acids occurred. 6. It is concluded that the blood amino nitrogen rise during shock results from an increased breakdown of protein in the peripheral tissues, the products of which accumulate either because they do not circulate through the liver at a sufficiently rapid rate or because with continued anoxia intrinsic damage may occur to the hepatic parenchyma so that it cannot dispose of amino acids.

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