Long-term results of additional pulmonary blood flow with bidirectional cavopulmonary shunt
- PDF / 416,871 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 0 Downloads / 204 Views
(2020) 15:279
RESEARCH ARTICLE
Open Access
Long-term results of additional pulmonary blood flow with bidirectional cavopulmonary shunt Ryosuke Kowatari1* , Yasuyuki Suzuki2, Kazuyuki Daitoku1 and Ikuo Fukuda1
Abstract Objective: We evaluated additional pulmonary blood flow at the time of bidirectional cavopulmonary shunt and its effects on the Fontan procedure and long-term outcome of Fontan circulation and liver function. Methods: We included 22 patients (16 boys, 6 girls) having undergone bidirectional cavopulmonary shunt with additional pulmonary blood flow between April 2002 and January 2016. Mean age and body weight were 20 ± 13 months and 7.5 ± 6.5 kg, respectively. We retrospectively evaluated the patients’ clinical data, including cardiac catheterization data, liver function, and liver fibrosis markers. Results: All patients were alive with a New York Heart Association status of I at the long-term follow-up. Changes between pre-bidirectional cavopulmonary shunt and 101 months after the Fontan procedure included the following: the cardiothoracic ratio of chest X-ray decreased from 52.2 ± 3.9% to 41.8 ± 5.9% (p < 0.001); systemic ventricle end-diastolic pressure decreased from 11.4 ± 3.2 mmHg to 6.9 ± 3.6 mmHg (p < 0.001); and the pulmonary artery index decreased from 485.1 ± 272.3 to 269.5 ± 100.5 (p = 0.02). Type IV collagen, hyaluronic acid, and procollagen levels increased over the normal range 116 months after the Fontan procedure. Conclusions: The additional pulmonary blood flow at the time of bidirectional cavopulmonary shunt may contribute to pulmonary arterial growth at the Fontan procedure with low pulmonary arterial resistance and without ventricle volume overload. The Fontan circulation was well-maintained at the long-term follow-up, while liver fibrosis markers were above their normal values. Keywords: Fontan, Additional pulmonary blood flow, Late complication, Liver function
Backgrounds The bidirectional cavopulmonary shunt (BCPS) is a palliative step in the staged Fontan procedure for patients with a functional univentricular heart [1, 2]. Studies have revealed that the preserved additional pulmonary blood flow (APBF) promotes interstage pulmonary artery (PA) growth and increases oxygen saturation in patients after BCPS [3, 4]. Moreover, APBF could preclude the * Correspondence: [email protected] 1 Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifucho, Hirosaki, Aomori 036-8562, Japan Full list of author information is available at the end of the article
arteriovenous fistula development in the lungs by exposure to hepatic venous flow [5]. Conversely, BCPS with APBF might prolong pleural effusion and increase ventricular volume overload, leading to the potential deterioration of atrioventricular valve regurgitation [6]. These short-term outcomes have been well discussed, whereas little is known about long-term outcomes in patients who underwent BCPS with APBF. Thus, whether APBF should be preserved at the time of BCPS remains controv
Data Loading...
