scholarly journals Superior Cavopulmonary Anastomosis in Patients With Bilateral Superior Caval Veins: Use of a Rolled Pericardial Graft to Create a Single Caval Vein

2018 ◽  
Vol 9 (4) ◽  
pp. 446-450 ◽  
Author(s):  
Tran-Thuy Nguyen ◽  
Ngoc-Thanh Le ◽  
Quoc-Hung Doan
Keyword(s):  
Blood Flow ◽  
Surgical Technique ◽  
Pulmonary Blood Flow ◽  
Thrombus Formation ◽  
Univentricular Heart ◽  
Caval Vein ◽  
Bidirectional Glenn ◽  
Cavopulmonary Anastomosis ◽  
Flow Through ◽  
New Surgical Technique

We propose a new surgical technique for superior cavopulmonary anastomosis in patients with functionally univentricular heart and bilateral superior caval veins. One of the reasons for failure of bidirectional Glenn shunts in patients with bilateral superior caval veins is the small caliber of one or both veins, with limited flow through each cavopulmonary anastomosis that can easily result in torsion, blockage, or clot formation. The conversion of two small superior caval veins into a single confluence which is large enough to connect with the pulmonary artery (PA) can resolve this problem. We present our experience with two cases in which a rolled pericardial graft was used to create a single caval vein to provide balanced pulmonary blood flow and yield growth of the central PA as well as reducing the likelihood of thrombus formation.

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.

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.

Targeted Increase in Pulmonary Blood Flow in a Bidirectional Glenn Circulation

2018 ◽  
Vol 30 (2) ◽  
pp. 182-188 ◽  
Author(s):  
Samuel L. Casella ◽  
Aditya Kaza ◽  
Pedro del Nido ◽  
James E. Lock ◽  
Audrey C. Marshall
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Bidirectional Glenn

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.

scholarly journals Elevated Low-Shear Blood Viscosity is Associated with Decreased Pulmonary Blood Flow in Children with Univentricular Heart Defects

2016 ◽  
Vol 37 (4) ◽  
pp. 789-801 ◽  
Author(s):  
Andrew L. Cheng ◽  
Cheryl M. Takao ◽  
Rosalinda B. Wenby ◽  
Herbert J. Meiselman ◽  
John C. Wood ◽  
...  
Keyword(s):  
Blood Flow ◽  
Blood Viscosity ◽  
Pulmonary Blood Flow ◽  
Heart Defects ◽  
Univentricular Heart ◽  
Low Shear

Zone 2 and zone 3 pulmonary blood flow

1987 ◽  
Vol 62 (5) ◽  
pp. 1982-1988 ◽  
Author(s):  
S. L. Soohoo ◽  
H. S. Goldberg ◽  
R. Graham ◽  
A. C. Jasper
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Venous Pressure ◽  
Alveolar Pressure ◽  
The West ◽  
Zonal Distribution ◽  
Zonal Model ◽  
Flow Channels ◽  
Flow Through ◽  
Pulmonary Arterial

In the West model of zonal distribution of pulmonary blood flow, increases in flow down zone 2 are attributed to an increase in driving pressure and a decrease in resistance resulting from recruitment and distension. The increase in flow down zone 3 is attributed to a decrease in resistance only. Recent studies indicate that, besides the pressure required to maintain flow through a vessel, there is an added pressure cost that must be overcome in order to initiate flow. These additional pressure costs are designated critical pressures (Pcrit). Because Pcrit exceed alveolar pressure, the distinction between zones in the West model becomes less secure, and the explanation for the increase in flow even in West zone 3 requires reexamination. We used two methods to test the hypothesis that the Pcrit is the pertinent backpressure to flow even in zone 3, when the pulmonary venous pressure (Ppv) exceeds alveolar pressure (PA) but is less than Pcrit in the isolated canine left caudal lobe. First, PA was maintained at 5 cmH2O, and pressure flow (P-Q) characteristics were obtained in zone 2 and zone 3. Next, with PA still at 5 cmH2O, we maintained a constant flow and measured the change in pulmonary arterial pressure as Ppv was varied. Both techniques indicated that the pertinent backpressure to flow was the greater of either Pcrit or Ppv and that PA was never the pertinent backpressure to flow. Also, our results indicate no significant change in the geometry of the flow channels between zone 2 and zone 3. These findings refine the zonal model of the pulmonary circulation.

Effects of Unilateral Hypoxia and Hypercapnia on Pulmonary Blood Flow Distribution in the Dog

1957 ◽  
Vol 191 (3) ◽  
pp. 446-452 ◽  
Author(s):  
Hans G. Borst ◽  
James L. Whittenberger ◽  
Erik Berglund ◽  
Maurice McGregor
Keyword(s):  
Carbon Dioxide ◽  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Flow Distribution ◽  
Blood Flow Distribution ◽  
Low Oxygen ◽  
Pulmonary Vasoconstriction ◽  
Vasoconstrictor Response ◽  
Flow Through ◽  
Oxygen Gas

Effects of hypoxia and of hypercapnia on pulmonary blood flow distribution were examined in 19 dogs. The blood flow through each lung was continuously recorded; the test gas was administered to one lung, and the other lung was used as the control. Low oxygen gas mixtures were administered to one lung for periods of 2–47 minutes. When constriction occurred, it began within one-half minute after the gas administration was started and reached a plateau within 8–20 minutes. Vasodilation was never observed. In most animals no vasomotor effect of hypoxia was found early in the experiment (less than 6 hr. after induction of anesthesia), but seven of the early nonreactors became positive later in the experiment. After 6–8 hours from induction of anesthesia, all animals tested showed a vasoconstrictor response to hypoxia. The administration to one lung of 5 or 10% carbon dioxide for 2–10 minutes was always accompanied by vasoconstriction in that lung. In dogs that showed unilateral pulmonary vasoconstriction during hypoxia, further vasoconstriction was produced by adding 5% carbon dioxide. Some of the contradictory results of other investigators may be explained by the refractory period observed in these experiments.

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