OBJECTIVE: To evaluate the extent of intrapulmonary right to left shunting in children after bidirectional cavopulmonary anastomosis (BCPA). DESIGN: Prospective study of patients who underwent BCPA in a single centre. PATIENTS: 17 patients with complex cyanotic congenital cardiac malformations who underwent BCPA at 1-45 months of age (median 21 months) were evaluated 15-64 months postoperatively (median 32 months). Five children between 1 and 10 years (median 5 years) with normal or surgically corrected intracardiac anatomy and peripheral pulmonary circulation who required V/Q scanning for other reasons were used as controls. INTERVENTIONS: All patients underwent cardiac catheterisation to exclude angiographically demonstrable venovenous collaterals followed by pulmonary perfusion scanning using (99m)technetium ((99m)Tc) labelled albumen microspheres to quantify the intrapulmonary right to left shunt. MAIN OUTCOME MEASURE: Percentage of intrapulmonary right to left shunt. RESULTS: The mean (SD) level of physiological right to left shunting found in the control group was 5.4 (2.3)%. All patients with BCPA showed the presence of a significantly higher level of intrapulmonary shunting (26.8 (16.9)%, p < 0.001). The degree of shunting was significantly increased in the subgroup of 11 patients with BCPA as the only source of pulmonary blood flow (34.9 (15.8)%), when compared to the six remaining patients with an additional source of pulmonary blood supply (12.0 (2.6)%, p < 0.001). There was a negative correlation between age at BCPA and the shunt percentage found in the patients with a competitive source of pulmonary blood flow (r = -0.63, p < 0. 01). CONCLUSIONS: Intrapulmonary right to left shunting develops in all patients following BCPA. This may be caused by a sustained and inappropriate vasodilatation resulting from absence or decreased levels of a substance that inhibits pulmonary vasodilatation. Augmenting BCPA with an additional source of blood flow containing hepatic factor limits the degree of intrapulmonary arteriovenous shunting and may help provide successful longer term palliation.
OBJECTIVE: To evaluate the extent of intrapulmonary right to left shunting in children after bidirectional cavopulmonary anastomosis (BCPA). DESIGN: Prospective study of patients who underwent BCPA in a single centre. PATIENTS: 17 patients with complex cyanotic congenital cardiac malformations who underwent BCPA at 1-45 months of age (median 21 months) were evaluated 15-64 months postoperatively (median 32 months). Five children between 1 and 10 years (median 5 years) with normal or surgically corrected intracardiac anatomy and peripheral pulmonary circulation who required V/Q scanning for other reasons were used as controls. INTERVENTIONS: All patients underwent cardiac catheterisation to exclude angiographically demonstrable venovenous collaterals followed by pulmonary perfusion scanning using (99m)technetium ((99m)Tc) labelled albumen microspheres to quantify the intrapulmonary right to left shunt. MAIN OUTCOME MEASURE: Percentage of intrapulmonary right to left shunt. RESULTS: The mean (SD) level of physiological right to left shunting found in the control group was 5.4 (2.3)%. All patients with BCPA showed the presence of a significantly higher level of intrapulmonary shunting (26.8 (16.9)%, p < 0.001). The degree of shunting was significantly increased in the subgroup of 11 patients with BCPA as the only source of pulmonary blood flow (34.9 (15.8)%), when compared to the six remaining patients with an additional source of pulmonary blood supply (12.0 (2.6)%, p < 0.001). There was a negative correlation between age at BCPA and the shunt percentage found in the patients with a competitive source of pulmonary blood flow (r = -0.63, p < 0. 01). CONCLUSIONS: Intrapulmonary right to left shunting develops in all patients following BCPA. This may be caused by a sustained and inappropriate vasodilatation resulting from absence or decreased levels of a substance that inhibits pulmonary vasodilatation. Augmenting BCPA with an additional source of blood flow containing hepatic factor limits the degree of intrapulmonary arteriovenous shunting and may help provide successful longer term palliation.
Authors: S A Reisner; Z Azzam; M Halmann; D Rinkevich; S Sideman; W Markiewicz; R Beyar Journal: J Am Soc Echocardiogr Date: 1994 Jan-Feb Impact factor: 5.251
Authors: Minoo N Kavarana; Jeffrey A Jones; Robert E Stroud; Scott M Bradley; John S Ikonomidis; Rupak Mukherjee Journal: Expert Rev Cardiovasc Ther Date: 2014-04-23
Authors: Andrew D Spearman; Ankan Gupta; Amy Y Pan; Emily I Gronseth; Karthikeyan Thirugnanam; Todd M Gudausky; Susan R Foerster; Ramani Ramchandran Journal: Semin Thorac Cardiovasc Surg Date: 2020-05-07
Authors: Minoo N Kavarana; Rupak Mukherjee; Shaina R Eckhouse; William F Rawls; Christina Logdon; Robert E Stroud; Risha K Patel; Elizabeth K Nadeau; Francis G Spinale; Eric M Graham; Geoffrey A Forbus; Scott M Bradley; John S Ikonomidis; Jeffrey A Jones Journal: Ann Thorac Surg Date: 2013-08-20 Impact factor: 4.330
Authors: David Michael McMullan; Vadiyala Mohan Reddy; William M Gottliebson; Norman H Silverman; Stanton B Perry; Frandics Chan; Frank Louis Hanley; Robert Kirk Riemer Journal: Pediatr Cardiol Date: 2007-11-28 Impact factor: 1.655
Authors: Teresa L Capasso; Sara M Trucco; Morgan Hindes; Tristin Schwartze; Jamie L Bloch; Jacqueline Kreutzer; Stephen C Cook; Cynthia S Hinck; Davide Treggiari; Brian Feingold; Andrew P Hinck; Beth L Roman Journal: Am J Respir Crit Care Med Date: 2021-01-15 Impact factor: 21.405