Parra-Bravo JR, Hernández-Villalón E, Josefa GH, Rojas-Bautista JC, Romero-Navarrete MA, Beirana-Palencia LG, Girón-Vargas AL, Zepeda-Sanabria JR, Vera-Canelo M

Language: Spanish
References: 23
Page: 87-93
PDF size: 119.74 Kb.

ABSTRACT

Objective: To examine the effects of bidirectional cavopulmonary anastomosis (Glenn shunt) on pulmonary blood flow distribution in a group of patients who underwent the procedure as an intermediate stage before the Fontan procedure. Patients and methods: Perfusion lung scans were preformed in 23 patients with a functional single ventricle with pulmonary atresia who underwent Glenn shunt anastomosis as an intermediate stage previous to the Fontan procedure, to determine the distribution of pulmonary blood flow. Follow-up studies included echocardiography in every patient and angiocardiography in five of them. Results: Perfusion lung scans showed symmetric distribution of pulmonary blood flow in 17% of the patients, whereas an asymmetric distribution of pulmonary blood flow was found in 83% of the patients. Overall there was a better distribution of pulmonary blood flow toward the right lung. The proximal diameter of the main pulmonary arteries showed a significant difference between them. Angiocardiography did not show an increase in mean pulmonary arterial pressure except in two patients. Conclusions: Our results suggest that an abnormal distribution of pulmonary blood flow might occur in those patients who underwent cavopulmonary anastomosis. Decrease in diameter of the main pulmonary arteries could be responsible of the perfusion abnormalities.

REFERENCES

1. Kopf GS, Laks H, Stansel HC, Hellenbrand WE, Kleinman ChS, Talner NS. Thirty-year follow up of superior vena cava-pulmonary artery (Glenn) shunts. J Thorac Cardiovasc Surg 1990; 100: 662-671.

2. Mainwaring RD, Lamberti JJ, Moore JW. The bidirectional Glenn and Fontan procedures integrated management of the patient with a functionally single ventricle. Cardiol Young 1996; 6: 198-207.

3. Quero M, Maitre MJ, Brito JM, Pérez de León I, López M, Rubio D. Anastomosis cavo-atriopulmonar. Rev Esp Cardiol 1993; 46: 101-118.

4. Castañeda AR. From Glenn to Fontan: a continuing evolution. Circulation 1992; 86 (Suppl II): 80-84.

5. Pridjian AK, Mendelsohn AM, Lupinetti FM, Beekman RH, Dick M, Server G et al. Usefulness of the bidirectional Glenn procedure as staged reconstruction for the functional single ventricle. Am J Cardiol 1993; 71: 959-962.

6. Day RW, Baker ChM, Caton JR, Hawkins JA, McGough EC. Bidirectional cavopulmonary shunt with additional source of pulmonary flow: an interim or final stage of palliation. Cardiol Young 1997; 7: 63-70.

7. Freedom RM, Nykanen D, Benson LN. The physiology of the bidirectional cavopulmonary connection . Ann Thorac Surg 1998; 66: 664-667.

8. Allgood NL, Alejos J, Davis C, Drinkwater DC, Lacks H. Effectiveness of the bidirectional Glenn shunt procedure for volume unloading in the single ventricle patient. Am J Cardiol 1994; 74: 834-836.

9. Mazzera E, Corno A, Picardo S, Di Donato R, Marino D, Costa D et al. Bidirectional cavo-pulmonary shunts: clinical applications as staged or definitive palliation. Ann Thorac Surg 1989: 47; 415-420.

10. Chang AC, Hanley FL, Wernovsky G, Rosenfeld HM, Wessel DL, Jonas RA et al. Early bi-directional cavopulmonary shunt in young infants. Postoperative course and early results. Circulation 1993; 88: 149-158.

11. Bridges ND, Jonas RA, Mayer JE. Bidirectional cavopulmonary anastomosis as interim palliation for high risk Fontan candidates-early results. Circulation 1990; 80(Suppl IV): 170-176.

12. Haworth SG, Reid L. Quantitative structural study of pulmonary circulation in the newborn with pulmonary atresia. Thorax 1977; 32: 129-133.

13. Ravinovitch M, Herrera-De León V, Constenda AR, Reid L. Growth and development of the pulmonary vascular bed in patients with Tetralogy of Fallot with and without pulmonary atresia. Circulation 1981; 64: 1234-1249.

14. Seliem MA, Murphy J, Vetter J, Heyman S, Norwood W. Lung perfusion patterns after bidirectional cavopulmonary anastomosis (Hemi-Fontan procedure). Pediatr Cardiol 1997; 18: 191-197.

15. Hopkins R, Armstrong B, Serwer G, Peterson R, Oldham N. Physiological rationale for a bi-directional cavopulmonary shunt. J Thorac Cardiovasc Surg 1985; 90: 391-398.

16. Cloutier AS, Ash JM, Smallhorn JF. Abnormal distribution of pulmonary blood flow after the Glenn shunt or Fontan operation: risk of development of arteriovenous fistulae. Circulation 1985; 72: 471-479.

17. Laks H, Mudd G, Standeven J, Fagan L, Willman VL. Long-term effect of the superior vena cava-pulmonary artery anastomosis on pulmonary blood flow. J Thorac Cardiovasc Surg 1977; 74: 253-260.

18. Matsushita T, Matsuda H, Ogawa M, Ohno K, Sano T, Nakano S et al. Assessment of the intrapulmonary ventilation-perfusion distribution after the Fontan procedure for complex cardiac anomalies: relation to pulmonary hemodynamics. JACC 1990; 15: 842-848.

19. Samanek M, Oppelt A, Kasalicky J, Voriskova M. Distribution of pulmonary blood flow after cavopulmonary anastomosis (Glenn operation). Br Heart J 1969; 31: 511-516.

20. Pennington DG, Nouri S, Ho J. Glenn shunt: long term results and current role in congenital heart operations. Ann Thorac Surg 1981; 31: 532-539.

21. Dollery C, West J, Wilcken D, Goodwin J, Hugh-Jones P. Regional pulmonary blood flow in patients with circulatory shunts. Br Heart J 1961; 23: 225-235.

22. Dunn J, Kirsh M, Harness J, Carrol M, Straker J, Sloan H. Hemodynamic, metabolic and hematologic effects of pulsatile cardiopulmonary bypass. J Thorac Cardiovasc Surg 1974; 68: 138-147.

23. Nakazawa M, Nojima K, Okuda H. Flow dynamics in the main pulmonary artery after the Fontan procedure in patients with tricuspid atresia or single ventricle. Circulation 1987; 75: 1117-1123.