Hypoxia is/is not the optimal means of reducing pulmonary blood flow in the preoperative single ventricle heart

2008 ◽  
Vol 104 (6) ◽  
pp. 1841-1842 ◽  
Author(s):  
David R. Jobes
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Single Ventricle

Single-centre experience in stenting arterial shunts for adult CHD patients with single-ventricle physiology and pulmonary blood flow dependent on arterial shunts

2018 ◽  
Vol 28 (12) ◽  
pp. 1431-1435
Author(s):  
Mohamed Kasem ◽  
James Bentham ◽  
John Thomson
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Single Ventricle ◽  
Well Being ◽  
Adult Patients ◽  
P Value ◽  
Intermediate Step ◽  
Medium Term ◽  
Single Ventricle Physiology ◽  
Post Procedure

AbstractObjectivesThe objectives of this study were to describe the approach to stenting arterial shunts in adult congenital patients with single-ventricle physiology and to assess the medium-term clinical and haemodynamic outcomes following stent insertion.BackgroundAdult patients with single-ventricle physiology and pulmonary blood flow dependent on a surgically placed arterial shunt who did not progress to venous palliation are extremely challenging to manage. Progressive cyanosis secondary to narrowing of the shunt has a marked impact on exercise tolerance and results in intolerable well-being for these patients. Stenting arterial shunts in adult patients is one method that can help improve pulmonary blood flow. There is very limited information in the literature about this patient.MethodsThis is a retrospective study for arterial shunts stenting conducted between 2008 and 2016. The peripheral oxygen saturations, the NYHA status, the haemoglobin, and the degree of atrio-ventricular valve regurgitation as assessed on transthoracic echo were compared before and 6–12 months after procedures.ResultsThere was a short-term improvement in oxygen saturations; the pre-procedure mean was 75.8 (SD 2.55)% (range 70–85%) and post-procedure mean was 83 (SD 2.52)% (range 78–87%), with a p value of 0.04. Haemoglobin level decreased from a pre-procedure mean of 22.06–20.28 g/L 6 months post procedure (range 18.1–24.4 to 13–23.3 g/L), with a p value of 0.44. NYHA class decreased from a mean of 3.2–2.2 post procedure. Left atrial volume for four of the cases did not change (22.6–76.6 ml [mean 48.4 ml] to 29.6–72.9 ml [mean 52 ml], p value: 0.83).ConclusionsStenting stenotic arterial shunts is a useful method to gain a medium-term improvement on the oxygen saturation and clinical symptoms, and may act as a useful intermediate step for further management plans.

Effect of Accessory Pulmonary Blood Flow on Survival After the Bidirectional Glenn Procedure

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Richard D. Mainwaring ◽  
John J. Lamberti ◽  
Karen Uzark ◽  
Robert L. Spicer ◽  
Mark W. Cocalis ◽  
...  
Keyword(s):  
Blood Flow ◽  
Mortality Rate ◽  
Pulmonary Blood Flow ◽  
Single Ventricle ◽  
Fontan Operation ◽  
Right Ventricular Outflow Tract ◽  
Bidirectional Glenn ◽  
Actuarial Analysis ◽  
Bidirectional Glenn Procedure ◽  
Glenn Procedure

Background —The bidirectional Glenn procedure (BDG) is used in the staged surgical management of patients with a functional single ventricle. Controversy exists regarding whether accessory pulmonary blood flow (APBF) should be left at the time of BDG to augment systemic saturation or be eliminated to reduce volume load of the ventricle. The present study was a retrospective review of patients undergoing BDG that was conducted to assess the influence of APBF on survival rates. Methods and Results —From 1986 through 1998, 149 patients have undergone BDG at our institution. Ninety-three patients had elimination of all sources of APBF, whereas 56 patients had either a shunt or a patent right ventricular outflow tract intentionally left in place to augment the pulmonary blood flow provided by the BDG. The operative mortality rate was 2.2% without APBF and 5.4% with APBF. The late mortality rate was 4.4% without APBF and 15.1% with APBF. Actuarial analysis demonstrates a divergence of the Kaplan-Meier curves in favor of patients in whom APBF was eliminated ( P <0.02). One hundred seven patients have subsequently undergone completion of their Fontan operation, so the actuarial analysis includes the operative risk of this second operation. Conclusions —The results suggest that the elimination of APBF at the time of BDG may confer a long-term advantage for patients with a functional single ventricle.

Superior Cavopulmonary Connection: Its Physiology, Limitations, and Anesthetic Implications

2020 ◽  
Vol 24 (4) ◽  
pp. 337-348
Author(s):  
Ray S. Choi ◽  
James A. DiNardo ◽  
Morgan L. Brown
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Single Ventricle ◽  
Fontan Procedure ◽  
Intermediate Stage ◽  
Ventricular Volume ◽  
Volume Load ◽  
Modes Of Failure ◽  
Anesthetic Considerations ◽  
Cavopulmonary Connection

The superior cavopulmonary connection (SCPC) or “bidirectional Glenn” is an integral, intermediate stage in palliation of single ventricle patients to the Fontan procedure. The procedure, normally performed at 3 to 6 months of life, increases effective pulmonary blood flow and reduces the ventricular volume load in patients with single ventricle (parallel circulation) physiology. While the SCPC, with or without additional sources of pulmonary blood flow, cannot be considered a long-term palliation strategy, there are a subset of patients who require SCPC palliation for a longer interval than the typical patient. In this article, we will review the physiology of SCPC, the consequences of prolonged SCPC palliation, and modes of failure. We will also discuss strategies to augment pulmonary blood flow in the presence of an SCPC. The anesthetic considerations in SCPC patients will also be discussed, as these patients may present for noncardiac surgery from infancy to adulthood.

Endovascular stents for relief of cyanosis in single-ventricle patients with shunt or conduit-dependent pulmonary blood flow

2006 ◽  
Vol 68 (2) ◽  
pp. 280-286 ◽  
Author(s):  
Christopher J. Petit ◽  
Matthew J. Gillespie ◽  
Jacqueline Kreutzer ◽  
Jonathan J. Rome
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Single Ventricle ◽  
Endovascular Stents

Study of Multiple Systemic-to-Pulmonary Shunts in Single Ventricle Hearts

2012 ◽  
Author(s):  
Mahdi Esmaily Moghadam ◽  
Tain-Yen Hsia ◽  
Bari Murtuza ◽  
Alison Marsden
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Single Ventricle ◽  
Ductus Arteriosus ◽  
Adverse Outcomes ◽  
Flow Dynamics ◽  
Single Institution ◽  
Shunt Occlusion ◽  
Flow Competition ◽  
Blalock Taussig Shunt

For newborns diagnosed with single ventricle hearts and insufficient blood flow to the lungs, their lack of oxygen in the blood can be remedied with a modified Blalock-Taussig shunt (BTshunt) between the innominate and pulmonary artery. However, some surgeons prefer to have two systemic-to-pulmonary shunts, by either leaving the ductus arteriosus open or construct a second BT shunt, to provide additional pulmonary blood flow. There have been clinical reports of premature shunt occlusion when more than one shunt is employed, and a recent audit of shunt operations at a single institution has revealed increased mortality. There are speculation that these adverse outcomes can be due to flow competition between the two shunts, and/or having too much pulmonary blood flow. The flow dynamics and cardiopulmonary physiology in single ventricle circulations where pulmonary blood flow is supplied by more than one shunt has not been studied previously. In this study, we adopted CFD-based multi-domain simulations to compare a range of shunt configurations to examine the issue of flow competition and pulmonary overcirulation.

Results of Palliation With an Initial Modified Blalock-Taussig Shunt in Neonates With Single Ventricle Anomalies Associated With Restrictive Pulmonary Blood Flow

2015 ◽  
Vol 99 (5) ◽  
pp. 1639-1647 ◽  
Author(s):  
Bahaaldin Alsoufi ◽  
Scott Gillespie ◽  
Brian Kogon ◽  
Brian Schlosser ◽  
Ritu Sachdeva ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Single Ventricle ◽  
Blalock Taussig Shunt
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