Does an additional source of pulmonary blood flow alter outcome after a bidirectional cavopulmonary shunt?

M. A. Frommelt, P. C. Frommelt, S. Berger, Andrew N Pelech, D. A. Lewis, J. S. Tweddell, S. B. Litwin

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Background: The bidirectional cavopulmonary shunt has become an important intermediate step in the treatment of pediatric patients with single ventricle physiology who are ultimately destined for palliative surgery. We wanted to know whether there would be risks or benefits if an additional source of pulmonary blood flow was left after a bidirectional cavopulmonary shunt. Methods and Results: We retrospectively reviewed the medical and surgical records of all patients who underwent a bidirectional cavopulmonary shunt at the Children's Hospital of Wisconsin between January 1991 and December 1993. A total of 43 patients were identified. Anatomic diagnoses included double inlet left ventricle (14 patients), tricuspid atresia (8 patients), pulmonary atresia with intact septum (6 patients), single right ventricle (5 patients), hypoplastic left heart (3 patients), unbalanced atrioventricular septal defect (3 patients), and other complex lesions (4 patients). We then divided the patients into two groups for purposes of analysis. Group 1 had only the cavopulmonary shunt as a source of pulmonary flow (22 patients); group 2 had an additional source of pulmonary flow (21 patients). Patient age at the time of cavopulmonary shunt ranged from 6 months to 12 years, with group 1 patients being younger (31 versus 45 months, P=.05). Group 2 patients had higher postoperative central venous pressures (17.8 versus 14.1 mm Hg, P<.001) and oxygen saturations (86% versus 81%, P<.001) than did group 1 patients. There was no statistical difference between groups in the number of chest tube days or hospital days. There was 1 early death in group 1 related to severe ventricular dysfunction and 1 late death in group 2 related to sepsis. Five patients in group 2 were readmitted to the hospital for drainage of a large chylothorax compared with none in group 1 (P<.02). Conclusions: We conclude that patients with an additional source of pulmonary blood flow after bidirectional cavopulmonary shunt have higher postoperative central venous pressures, have higher oxygen saturations, and are at risk for the late development of a chylothorax.

Original languageEnglish (US)
JournalCirculation
Volume92
Issue number9 SUPPL.
StatePublished - 1995
Externally publishedYes

Fingerprint

Fontan Procedure
Lung
Right Heart Bypass
Chylothorax
Central Venous Pressure
Heart Ventricles
Tricuspid Atresia
Oxygen
Pulmonary Atresia
Ventricular Dysfunction
Chest Tubes

Keywords

  • heart defects, congenital
  • pediatrics
  • shunts
  • surgery

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Frommelt, M. A., Frommelt, P. C., Berger, S., Pelech, A. N., Lewis, D. A., Tweddell, J. S., & Litwin, S. B. (1995). Does an additional source of pulmonary blood flow alter outcome after a bidirectional cavopulmonary shunt? Circulation, 92(9 SUPPL.).

Does an additional source of pulmonary blood flow alter outcome after a bidirectional cavopulmonary shunt? / Frommelt, M. A.; Frommelt, P. C.; Berger, S.; Pelech, Andrew N; Lewis, D. A.; Tweddell, J. S.; Litwin, S. B.

In: Circulation, Vol. 92, No. 9 SUPPL., 1995.

Research output: Contribution to journalArticle

Frommelt, MA, Frommelt, PC, Berger, S, Pelech, AN, Lewis, DA, Tweddell, JS & Litwin, SB 1995, 'Does an additional source of pulmonary blood flow alter outcome after a bidirectional cavopulmonary shunt?', Circulation, vol. 92, no. 9 SUPPL..
Frommelt MA, Frommelt PC, Berger S, Pelech AN, Lewis DA, Tweddell JS et al. Does an additional source of pulmonary blood flow alter outcome after a bidirectional cavopulmonary shunt? Circulation. 1995;92(9 SUPPL.).
Frommelt, M. A. ; Frommelt, P. C. ; Berger, S. ; Pelech, Andrew N ; Lewis, D. A. ; Tweddell, J. S. ; Litwin, S. B. / Does an additional source of pulmonary blood flow alter outcome after a bidirectional cavopulmonary shunt?. In: Circulation. 1995 ; Vol. 92, No. 9 SUPPL.
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abstract = "Background: The bidirectional cavopulmonary shunt has become an important intermediate step in the treatment of pediatric patients with single ventricle physiology who are ultimately destined for palliative surgery. We wanted to know whether there would be risks or benefits if an additional source of pulmonary blood flow was left after a bidirectional cavopulmonary shunt. Methods and Results: We retrospectively reviewed the medical and surgical records of all patients who underwent a bidirectional cavopulmonary shunt at the Children's Hospital of Wisconsin between January 1991 and December 1993. A total of 43 patients were identified. Anatomic diagnoses included double inlet left ventricle (14 patients), tricuspid atresia (8 patients), pulmonary atresia with intact septum (6 patients), single right ventricle (5 patients), hypoplastic left heart (3 patients), unbalanced atrioventricular septal defect (3 patients), and other complex lesions (4 patients). We then divided the patients into two groups for purposes of analysis. Group 1 had only the cavopulmonary shunt as a source of pulmonary flow (22 patients); group 2 had an additional source of pulmonary flow (21 patients). Patient age at the time of cavopulmonary shunt ranged from 6 months to 12 years, with group 1 patients being younger (31 versus 45 months, P=.05). Group 2 patients had higher postoperative central venous pressures (17.8 versus 14.1 mm Hg, P<.001) and oxygen saturations (86{\%} versus 81{\%}, P<.001) than did group 1 patients. There was no statistical difference between groups in the number of chest tube days or hospital days. There was 1 early death in group 1 related to severe ventricular dysfunction and 1 late death in group 2 related to sepsis. Five patients in group 2 were readmitted to the hospital for drainage of a large chylothorax compared with none in group 1 (P<.02). Conclusions: We conclude that patients with an additional source of pulmonary blood flow after bidirectional cavopulmonary shunt have higher postoperative central venous pressures, have higher oxygen saturations, and are at risk for the late development of a chylothorax.",
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AU - Pelech, Andrew N

AU - Lewis, D. A.

AU - Tweddell, J. S.

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AB - Background: The bidirectional cavopulmonary shunt has become an important intermediate step in the treatment of pediatric patients with single ventricle physiology who are ultimately destined for palliative surgery. We wanted to know whether there would be risks or benefits if an additional source of pulmonary blood flow was left after a bidirectional cavopulmonary shunt. Methods and Results: We retrospectively reviewed the medical and surgical records of all patients who underwent a bidirectional cavopulmonary shunt at the Children's Hospital of Wisconsin between January 1991 and December 1993. A total of 43 patients were identified. Anatomic diagnoses included double inlet left ventricle (14 patients), tricuspid atresia (8 patients), pulmonary atresia with intact septum (6 patients), single right ventricle (5 patients), hypoplastic left heart (3 patients), unbalanced atrioventricular septal defect (3 patients), and other complex lesions (4 patients). We then divided the patients into two groups for purposes of analysis. Group 1 had only the cavopulmonary shunt as a source of pulmonary flow (22 patients); group 2 had an additional source of pulmonary flow (21 patients). Patient age at the time of cavopulmonary shunt ranged from 6 months to 12 years, with group 1 patients being younger (31 versus 45 months, P=.05). Group 2 patients had higher postoperative central venous pressures (17.8 versus 14.1 mm Hg, P<.001) and oxygen saturations (86% versus 81%, P<.001) than did group 1 patients. There was no statistical difference between groups in the number of chest tube days or hospital days. There was 1 early death in group 1 related to severe ventricular dysfunction and 1 late death in group 2 related to sepsis. Five patients in group 2 were readmitted to the hospital for drainage of a large chylothorax compared with none in group 1 (P<.02). Conclusions: We conclude that patients with an additional source of pulmonary blood flow after bidirectional cavopulmonary shunt have higher postoperative central venous pressures, have higher oxygen saturations, and are at risk for the late development of a chylothorax.

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