Transcatheter closure of antegrade pulmonary blood flow with Amplatzer muscular VSD occluder after Fontan operation

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.

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Maldistribution of pulmonary blood flow in patients after the Fontan operation is associated with worse exercise capacity

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-018-0505-4 ◽

2018 ◽

Vol 20 (1) ◽

Cited By ~ 8

Author(s):

Tarek Alsaied ◽

Lynn A. Sleeper ◽

Marco Masci ◽

Sunil J. Ghelani ◽

Nina Azcue ◽

...

Keyword(s):

Blood Flow ◽

Exercise Capacity ◽

Pulmonary Blood Flow ◽

Fontan Operation

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Ventilation with external high frequency oscillation around a negative baseline increases pulmonary blood flow after the Fontan operation

Cardiology in the Young ◽

10.1017/s1047951100001049 ◽

1992 ◽

Vol 2 (3) ◽

pp. 277-280 ◽

Cited By ~ 14

Author(s):

Daniel J. Penny ◽

Zamir Hayek ◽

Peter Rawle ◽

Michael L. Rigby ◽

Andrew N. Redington

Keyword(s):

Blood Flow ◽

Negative Pressure ◽

High Frequency ◽

Pulmonary Blood Flow ◽

Positive Pressure Ventilation ◽

Fontan Operation ◽

Intermittent Positive Pressure Ventilation ◽

High Frequency Oscillation ◽

Positive Pressure ◽

Frequency Oscillation

AbstractIn this prospective study, pulmonary blood flow was measured using transesophageal Doppler echocardiography to assess whether ventilation by means of external high frequency oscillation around a negative pressure baseline can increase pulmonary blood flow, compared to intermittent positive pressure ventilation, in five patients after the Fontan operation. Pulmonary blood flow was measured when patients were ventilated by means of intermittent positive pressure ventilation and again during equivalent negative pressure ventilation using the external oscillatory technique. When compared to that with intermittent positive pressure ventilation, ventilation using external high frequency oscillation increased pulmonary blood flow by 116 ±61.5% (p=0.013). These results show that ventilation using an external oscillatory device with a mean negative chamber pressure may provide hemodynamic advantages in patients requiring assisted ventilation after the Fontan operation.

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Abstract 17326: The Effect of Maintenance of Antegrade Pulmonary Blood Flow Upon Bidirectional Glenn on Pre- and Post-Fontan Outcomes

Circulation ◽

10.1161/circ.138.suppl_1.17326 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Jae Suk Baek ◽

Chun Soo Park ◽

Eun Seok Choi ◽

Bo Sang Kwon ◽

Tae-Jin Yun ◽

...

Keyword(s):

Blood Flow ◽

Oxygen Saturation ◽

Pulmonary Blood Flow ◽

Fontan Operation ◽

Advantages And Disadvantages ◽

Bidirectional Glenn ◽

Pulmonary Arterial ◽

Group 2 ◽

The Impact ◽

Group 1

Introduction: Maintaining pulsatility at the time of bidirectional Glenn (BDG) has theoretical advantages and disadvantages. The practice is diverse throughout the centers and individual surgeons without clear rationale behind its application. We sought to investigate the impact of antegrade pulmonary blood flow on pre- and post-Fontan outcomes. Methods: From 2003 through June 2014, among 237 patients who underwent BDG as an interim palliation for functional single ventricle (FSV), patients with preexisting pulmonary blood flow from the ventricle before BDG were included and patients undergoing Kawashima operation or having history of Norwood operation or bilateral pulmonary arterial band were excluded (n=151). Patients were grouped by their presence or absence of antegrade pulmonary blood flow following BDG: group 1 (pulsatile) (n=73) or group 2 (non-pulsatile) (n=78). The pre- and post-Fontan outcomes were compared between two groups. Results: Age and weight at BDG were 7 months and 7.8kg. Oxygen saturation was higher in group 1 (84±4%) compared to group 2 (82±4%) before Fontan (p<0.001). The level of brain natriuretic peptide (BNP) was similar before Fontan (p=0.966). In pre-Fontan cardiac catheterization, mean pulmonary arterial pressure was similar (Group 1: 11±4mmHg vs. Group 2: 10±4mmHg, p=0.146), McGoon ratio seemed higher in group 1(2.6±0.6) compared to group 2(2.3±0.4) (p=0.057), and pulmonary vascular resistance was lower in group 1(1.3±0.7) compared to group 2(1.6±0.7)(p=0.038). A total of 136 patients (90%) underwent Fontan operation. Duration of stay in the intensive care unit (p=0.766), stay in hospital (p=0.142), and indwelling chest tube (p=0.128) was not different between groups. Overall survival after BDG was better in group 2 (p=0.046) [Figure]. In multivariable analysis, maintenance of pulsatility was identified as a risk factor for survival after BDG (p=0.012, HR 4.1 [CI 1.4-12.4]). Conclusions: Maintaining pulsatility at the time of BDG in FSV might be beneficial for pulmonary arterial growth and oxygen saturation without increasing BNP. However, such beneficial effect did not have a positive effect on subsequent Fontan outcome. Attention must be paid to the negative effect of pulsatility on overall post-BDG survival.

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A Hemi Fontan Operation Performed by an Engineer: Considerations on Virtual Surgery

Volume 1B: Extremity; Fluid Mechanics; Gait; Growth, Remodeling, and Repair; Heart Valves; Injury Biomechanics; Mechanotransduction and Sub-Cellular Biophysics; MultiScale Biotransport; Muscle, Tendon and Ligament; Musculoskeletal Devices; Multiscale Mechanics; Thermal Medicine; Ocular Biomechanics; Pediatric Hemodynamics; Pericellular Phenomena; Tissue Mechanics; Biotransport Design and Devices; Spine; Stent Device Hemodynamics; Vascular Solid Mechanics; Student Paper and Design Competitions ◽

10.1115/sbc2013-14451 ◽

2013 ◽

Author(s):

Giovanni Biglino ◽

Ethan Kung ◽

Adam Dorfman ◽

Andrew M. Taylor ◽

Edward Bove ◽

...

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Fontan Operation ◽

Hybrid Approach ◽

Pulmonary Arteries ◽

Virtual Surgery ◽

Extracardiac Conduit ◽

Lateral Tunnel ◽

The Right ◽

Cavopulmonary Connection

Single ventricle circulation, characterized at birth by a rudimentary or absent left or right ventricle, presents a challenging and life-threatening physiological scenario. Surgical palliation aims to restore the balance between systemic and pulmonary blood flow and is staged, each of the three stages presenting the surgeon with different options: - Stage 1 (Norwood procedure) involves different types of shunting to source pulmonary blood flow, or recently a hybrid approach [1]; - Stage 2 can involve a superior cavopulmonary connection (Glenn operation) or patching between the right atrium and the pulmonary arteries (Hemi Fontan operation [2]); - Stage 3 involves a total cavopulmonary connection with extracardiac conduit or lateral tunnel, or with novel alternatives such as the Y-graft [3].

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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

Cardiology in the Young ◽

10.1017/s1047951106320239 ◽

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.

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Echocardiographic and Radionuclide Pulmonary Blood Flow Patterns After Transcatheter Closure of Patent Ductus Arteriosus

Circulation ◽

10.1161/01.cir.94.2.126 ◽

1996 ◽

Vol 94 (2) ◽

pp. 126-129 ◽

Cited By ~ 26

Author(s):

Hugues Dessy ◽

Joris P.S. Hermus ◽

Freek van den Heuvel ◽

H.Y. Oei ◽

Eric P. Krenning ◽

...

Keyword(s):

Blood Flow ◽

Patent Ductus Arteriosus ◽

Pulmonary Blood Flow ◽

Transcatheter Closure ◽

Ductus Arteriosus ◽

Flow Patterns ◽

Blood Flow Patterns ◽

Patent Ductus

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Outcomes of Primary Bidirectional Glenn in Children with Single Ventricle Physiology and Increased Pulmonary Blood Flow

The Heart Surgery Forum ◽

10.1532/hsf.3299 ◽

2020 ◽

Vol 23 (6) ◽

pp. E850-E856

Author(s):

Ahmed Mohamed Dohain ◽

Muhammed A. Mashat ◽

Ahmed M.A Al-Mojaddidi ◽

Mohamed E. Abdelmotaleb ◽

Abdulla A. Mashat ◽

...

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Single Ventricle ◽

Fontan Operation ◽

Length Of Hospital Stay ◽

University Hospital ◽

Second Stage ◽

Bidirectional Glenn ◽

Significant Difference ◽

King Abdulaziz University

Background: We reported our experience in managing patients with single ventricle (SV) physiology and increased pulmonary blood flow (PBF), aiming to assess if it is feasible to proceed with primary Bidirectional Glenn (BDG) without a prior operation to limit PBF. Materials and methods: This is a retrospective study with 51 consecutive patients who underwent BDG operation as a primary operation or a second stage prior to the definitive Fontan operation at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia between 2010 and 2018. Patients were categorized into two groups based on their PBF prior to the operation: Patients who had SV physiology and increased PBF (seven patients) vs. patients with SV physiology and restricted PBF (44 patients). Results: The median age for the increased PBF group was 9.9 months [interquartile range (IQR): 2-16.9 months], and the median age for the restricted PBF group was 15.3 months (IQR: 6.7-42.6 months). Although the length of hospital stay was longer in patients with increased PBF (P = 0.039), we couldn't find a statistically significant difference in early mortality, duration of mechanical ventilation, length of pleural drainage, and length of intensive care unit (ICU) stay between the groups. Conclusion: In our experience, we found that primary BDG could be done safely for patients having SV physiology and increased PBF with acceptable short-term outcomes. It might further reduce the morbidity and mortality for those patients by avoiding the risk of initial pulmonary artery banding or aortopulmonary shunts.

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