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. 1999 Jan;81(1):67–72. doi: 10.1136/hrt.81.1.67

Pulmonary and caval flow dynamics after total cavopulmonary connection

K Houlind 1, E Stenbog 1, K Sorensen 1, K Emmertsen 1, O Hansen 1, L Rybro 1, V Hjortdal 1
PMCID: PMC1728916  PMID: 10220548

Abstract

Objective—To assess flow dynamics after total cavopulmonary connection (TCPC).
Design—Cross-sectional study.
Setting—Aarhus University Hospital. 
Patients—Seven patients (mean age 9 (4-18) years) who had previously undergone a lateral tunnel TCPC mean 2 (0.3-5) years earlier. 
Interventions—Pressure recordings (cardiac catheterisation), flow volume, and temporal changes of flow in the lateral tunnel, superior vena cava, and right and left pulmonary arteries (magnetic resonance velocity mapping).
Results—Superior vena cava flow was similar to lateral tunnel flow (1.7 (0.6-1.9) v 1.3 (0.9-2.4) l/min*m2) (NS), and right pulmonary artery flow was higher than left pulmonary artery flow (1.7 (0.6-4.3) v 1.1 (0.8-2.5) l/min*m2, p < 0.05). The flow pulsatility index was highest in the lateral tunnel (2.0 (1.1-8.5)), lowest in the superior vena cava (0.8 (0.5-2.4)), and intermediate in the left and right pulmonary arteries (1.6 (0.9-2.0) and 1.2 (0.4-1.9), respectively). Flow and pressure waveforms were biphasic with maxima in atrial systole and late ventricular systole.
Conclusions—Following a standard lateral tunnel TCPC, flow returning via the superior vena cava is not lower than flow returning via the inferior vena cava as otherwise seen in healthy subjects; flow distribution to the pulmonary arteries is optimal; and some pulsatility is preserved primarily in the lateral tunnel and the corresponding pulmonary artery. This study provides in vivo data for future in vitro and computer model studies.

 Keywords: blood flow dynamics;  total cavopulmonary connection;  congenital heart disease

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Figure 1  .

Figure 1  

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Schematic drawing of the TCPC and the planes used for MR flow measurements. LPA, left pulmonary artery; LSVC, left superior vena cava; LT, lateral tunnel; RPA, right pulmonary artery; RSVC, right superior vena cava

Figure 2  .

Figure 2  

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Flow volume curves from the four measurement planes. The instantaneous pressure difference between the lateral tunnel (LT) and the left pulmonary artery (LPA) and between the superior vena cava (SVC) and the right pulmonary artery (RPA) in a typical patient (patient 4). The ECG is shown at the bottom. The flow variation in the lateral tunnel resembles the variations in the pressure gradient between the lateral tunnel and the left pulmonary artery. Flow and pressure curves from the lateral tunnel−left pulmonary artery and from the superior vena cava−right pulmonary artery look similar.

Selected References

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