the clinical impact of antegrade pulmonary blood flow on the bidirectional cavopulmonary shunt in infants

2004 ◽  
Vol 14 (S3) ◽  
pp. 44-47 ◽  
Author(s):  
lucia migliazza ◽  
francesco seddio ◽  
francesco paolo annecchino ◽  
giancarlo crupi
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Ventricular Dysfunction ◽  
Fontan Procedure ◽  
Volume Overload ◽  
Clinical Impact ◽  
Cavopulmonary Anastomosis ◽  
Alternative Sources ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Cavopulmonary Shunt

the bidirectional cavopulmonary anastomosis is commonly used in the palliation of patients with a functionally univentricular physiology. the management of alternative sources of flow of blood to the lungs, as well as the magnitude of acceptable accessory blood flow at the time of surgery, nonetheless, remains controversial. these issues are particularly significant when a cavopulmonary anastomosis is performed in infants who may become candidates for a fontan procedure. indeed, a long-standing volume overload, which is invariably associated with the maintenance of accessory sources of pulmonary blood flow, may result in systemic ventricular dysfunction. these observations prompted us to review the influence of antegrade pulmonary blood flow in the management of infants undergoing a cavopulmonary anastomosis.

Results of Additional Pulsatile Pulmonary Blood Flow with Bidirectional Glenn Cavopulmonary Anastomosis: Positive Effect on Main Pulmonary Artery Growth and Less Need for Fontan Conversion

2013 ◽  
Vol 16 (1) ◽  
pp. 30 ◽  
Author(s):  
Orhan Saim Demirtürk ◽  
Murat Güvener ◽  
İsa Coşkun ◽  
Selman Vefa Yıldırım
Keyword(s):  
Blood Flow ◽  
Pulmonary Artery ◽  
Oxygen Pressure ◽  
Pulmonary Blood Flow ◽  
Main Pulmonary Artery ◽  
Bidirectional Glenn ◽  
Cavopulmonary Anastomosis ◽  
Cavopulmonary Shunt ◽  
Partial Oxygen

<strong>Background</strong>: Additional antegrade pulsatile pulmonary blood flow obtained by leaving the main pulmonary artery patent during bidirectional cavopulmonary shunt has been shown to give additional benefits to the bidirectional Glenn cavopulmonary anastomosis. We retrospectively evaluated our 20-patient pulsatile Glenn series in order to find out whether these salutary effects were valid or not.<br /><strong>Methods</strong>: Between June 2007 and November 2011, 20 patients (11 girls and 9 boys) with single-ventricle physiology underwent bidirectional cavopulmonary anastomosis. The additional source of blood flow was through the unligated main pulmonary artery in all patients. A retrospective review of our surgical experience was performed focusing on the role of additional pulmonary flow. Medical records and perioperational and postoperative follow-up data including clinical outcomes were retrospectively retrieved and analyzed.<br /><strong>Results</strong>: Two patients died in the early postoperative period. One patient died in the follow-up period. Mean follow-up time was 23.9 ± 15.7 months. No superior vena cava syndrome and no increase in pulmonary vascular resistance were observed. Improvement of partial oxygen pressure after pulsatile Glenn has been shown in all patients (P = .00). At a mean interval of 22.9 months, main pulmonary artery size continued to increase after pulsatile Glenn cavopulmonary anastomosis (P = .028). Only 1 patient was converted to Fontan type circulation after pulsatile Glenn cavopulmonary anastomosis.<br /><strong>Conclusions</strong>: The pulsatile cavopulmonary shunt is a useful procedure in the early and intermediate term management of patients with a functional univentricular heart. It improves partial oxygen pressure and the impact of pulsatility on the main pulmonary artery.

Effects of controlled antegrade pulmonary blood flow on cardiac function after bidirectional cavopulmonary anastomosis

2003 ◽  
Vol 76 (6) ◽  
pp. 1917-1921 ◽  
Author(s):  
Joseph Caspi ◽  
Timothy W Pettitt ◽  
T.Bruce Ferguson ◽  
Aluizio R Stopa ◽  
Satinder K Sandhu
Keyword(s):  
Blood Flow ◽  
Cardiac Function ◽  
Pulmonary Blood Flow ◽  
Cavopulmonary Anastomosis ◽  
Bidirectional Cavopulmonary Anastomosis

the effect of the position of an additional systemic-to-pulmonary shunt on the fluid dynamics of the bidirectional cavo-pulmonary anastomosis

2004 ◽  
Vol 14 (S3) ◽  
pp. 38-43 ◽  
Author(s):  
francesca gervaso ◽  
silvia kull ◽  
giancarlo pennati ◽  
francesco migliavacca ◽  
gabriele dubini ◽  
...  
Keyword(s):  
Pulmonary Stenosis ◽  
Fontan Procedure ◽  
Pulmonary Arteries ◽  
Volume Overload ◽  
Additional Source ◽  
Arteriovenous Fistulas ◽  
Palliative Procedure ◽  
Cavopulmonary Anastomosis ◽  
One Step ◽  
Bidirectional Cavopulmonary Anastomosis

the bidirectional cavo-pulmonary anastomosis is a well-established palliative procedure for patients with a functionally univentricular circulation. it is usually considered one step in preparation for fontan procedure, but it may be performed as a long-term palliation for patients deemed to be at high-risk. in this subset of patients, a valuable surgical option could be to add, or maintain, an additional source of flow of blood to the lungs, either derived from a patent but banded trunk or one protected by native pulmonary stenosis, or a systemic-to-pulmonary arterial shunt. the risk and benefits of providing an additional source of pulmonary flow after construction of a bidirectional cavopulmonary anastomosis are strongly debated. in terms of benefit, the arterial saturation of oxygen is increased due to the greater ratio of pulmonary-to-systemic flow, arteriovenous fistulas are prevented and, as a consequence of the arterial pulsatile flow, the pulmonary arteries are stimulated to grow. the most significant drawbacks are volume overload of the functionally single ventricle, and higher pressures compared to an isolated bidirectional cavopulmonary anastomosis.

The clinical impact of percutaneous balloon expandable endovascular stents in the management of early postoperative vascular obstruction

1996 ◽  
Vol 6 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Yoshiho Hatai ◽  
David G. Nykanen ◽  
William G. Williams ◽  
Robert M. Freedom ◽  
Lee N. Benson
Keyword(s):  
Postoperative Period ◽  
Fontan Procedure ◽  
Symptomatic Improvement ◽  
Clinical Impact ◽  
Arterial Stenosis ◽  
Low Cardiac Output Syndrome ◽  
Endovascular Stents ◽  
Percutaneous Balloon ◽  
Cavopulmonary Anastomosis ◽  
Bidirectional Cavopulmonary Anastomosis

AbstractTo assess the clinical impact of percutaneously implanted balloon expandable endovascular stents on patient management, we reviewed 20 children aged 14 days to 4.8 years (median 1.3 years) with residual vascular obstructions in the immediate postoperative period. Patients included 11 with pulmonary arterial stenosis, five with stenosis of venous pathways after a modified Fontan procedure or bidirectional cavopulmonary anastomosis, and four with a restrictive modified Blalock-Taussig shunt. Placement of the stent was optimal in 18 of 20 patients (24 of 26 Palmaz or Palmaz-Schatz implants). In two patients, rupture of the balloon resulted in malposition of the stent. Reoperation was avoided and symptomatic improvement was noted in 11 of 20 patients (55%), while procedural complications occurred in eight patients. Seven of 10 patients presenting with a low cardiac output syndrome died despite relief of the obstructions. This early experience supports consideration of the application of these devices in the management of significant vascular obstructive lesions in the immediate postoperative period, thus avoiding early reoperation in this profoundly compromised population.

Abstracts for the British Congenital Cardiac Association Annual Meeting: The Barbican, London, 24–25 November 2005: Poster Presentations: Transcatheter closure of ventricle-pulmonary artery communications after cavopulmonary shunt or Fontan procedure

2006 ◽  
Vol 16 (3) ◽  
pp. 321-322
Author(s):  
T. Desai ◽  
J. G. C. Wright ◽  
R. Dhillon ◽  
O. Stumper
Keyword(s):  
Blood Flow ◽  
Pulmonary Artery ◽  
Cardiac Failure ◽  
Pulmonary Blood Flow ◽  
Transcatheter Closure ◽  
Fontan Procedure ◽  
Pleural Effusions ◽  
Gradual Improvement ◽  
Catheter Closure ◽  
Cavopulmonary Shunt

Background: Ventricle-pulmonary artery connections are rare in patients after the Fontan procedure. However, these can cause significant long term problems. Hence the catheter occlusion of the anterograde flow in these patients would be beneficial. Further, in patients with a cavopulmonary shunt anterograde pulmonary blood flow is frequently maintained, but, in some patients, can cause significant volume loading of the heart or can complicate the subsequent Fontan procedure. Objective: To evaluate the use of interventional catheter closure of a ventricle-pulmonary artery communication in the setting of a cavopulmonary shunt or after the Fontan procedure. Patients and methods:This was a retrospective study at a tertiary referral centre. Eight patients (Age: 1.5–18 years, mean 7.8 years) underwent transcatheter closure of a ventricle-pulmonary artery communication. Indications were cardiac failure or persistent pleural effusions after cavopulmonary shunt (n = 2) or after Fontan (n = 3) and abolishing the volume load of the single ventricle prior to Fontan completion (n = 3). Results: Devices used were 17 mm Rashkind Umbrella device (n = 1), Amplatzer PDA device (n = 7) and Amplatzer ASD device (n = 1). One patient required two devices. There were no procedural complications. All 3 patients with prolonged pleural effusions (1 post CP shunt and 2 post Fontan) showed complete resolution of effusions between 4 and 10 days after catheter closure. Two patients underwent transcatheter occlusion for progressive ventricular dilatation and cardiac failure. The first patient was post Fontan and showed gradual improvement in ventricular function. The second patient after CP shunt died 48 hours post intervention (non procedure related cardiac death). Three patients underwent catheter closure to off-load the systemic ventricle prior to the Fontan procedure. The device had to be removed prior to release in 1 patient, due to unsatisfactory position. All 3 patients underwent successful completion of Fontan 6 weeks to 3 months post catheter. Conclusions: Transcatheter closure of ventricle-pulmonary artery communication is a safe and effective technique in the treatment of selected patients after CP shunt or Fontan procedure with early or late complications due to inappropriate pulmonary blood flow. This intervention should also be considered prior to the Fontan procedure in selected patients with ventricular overload.

scholarly journals Long-term Results of Additional Pulmonary Blood Flow With Bidirectional Cavopulmonary Shunt

2020 ◽  
Author(s):  
Ryosuke Kowatari ◽  
Yasuyuki Suzuki ◽  
Kazuyuki Daitoku ◽  
Ikuo Fukuda
Keyword(s):  
Blood Flow ◽  
Liver Fibrosis ◽  
Liver Function ◽  
Pulmonary Blood Flow ◽  
Fontan Procedure ◽  
Bidirectional Cavopulmonary Shunt ◽  
Pulmonary Arterial ◽  
Cavopulmonary Shunt

Abstract Objective: We evaluatedadditional pulmonary blood flowat the time of bidirectional cavopulmonary shunt andits effectson the Fontan procedure andlong-term outcome of Fontan circulation and liver function.Methods: We included 22patients (16 boys, 6 girls) having undergonebidirectional cavopulmonary shunt with additional pulmonary blood flow between April 2002 and January 2016. Mean ageand body weight were 20 ±13 monthsand 7.5 ± 6.5 kg, respectively.We retrospectively evaluated the patients'clinical data,including cardiac catheterization data, liver function, and liver fibrosis markers.Results: All patients werealive with a New York Heart Association status of I at the long-term follow-up. Changes between pre-bidirectional cavopulmonary shunt and 101 months after the Fontan procedure included the following:the cardiothoracic ratio of chest X-ray decreased from 52.2 ± 3.9% to 41.8 ± 5.9% (p<0.001);systemic ventricle end-diastolic pressure decreased from 11.4±3.2 mmHg to 6.9±3.6mmHg(p<0.001);and the pulmonary artery index decreased from 485.1±272.3 to 269.5 ± 100.5(p=0.02). Type IV collagen, hyaluronic acid, and procollagen levels increased over the normal range 116 months after the Fontan procedure.Conclusions:The additional pulmonary blood flowat the time of bidirectional cavopulmonary shuntmaycontributeto pulmonary arterial growth at the Fontan procedure with low pulmonary arterial resistanceand without ventricle volumeoverload. The Fontan circulation was well-maintained at thelong-term follow-up, while liver fibrosis markerswere above their normal values.

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