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. 1996 May;75(5):513–517. doi: 10.1136/hrt.75.5.513

Pulmonary blood supply in bidirectional cavopulmonary anastomosis with pulsatile pulmonary blood flow: quantitative analysis using radionuclide angiocardiography.

O Reich 1, P Horváth 1, C Ruth 1, M Krejcír 1, J Skovránek 1
PMCID: PMC484352  PMID: 8665347

Abstract

OBJECTIVE: To establish a non-invasive method for quantitative analysis of pulmonary perfusion in patients with bidirectional cavopulmonary anastomosis (BCPA) and sources of pulsatile blood flow. The method should quantify left to right lung flow ratio and relative contribution of BCPA and sources of pulsatile blood flow to perfusion of each lung. DESIGN: A pilot study using radionuclide angiocardiography for quantitative analysis and for visualisation of cavo-caval collaterals. No criterion standard is available. SETTING: Tertiary care centre, ambulatory and hospital inpatient care. PATIENTS: Consecutive sample of 18 patients with BCPA and sources of pulsatile blood flow. RESULTS: In eight patients (44%) cavocaval collaterals prevented quantitative analysis. In 10 patients without cavo-caval collaterals, BCPA provided 42.3 (SEM 3.4)% of total pulmonary blood flow. From the total BCPA flow, 67.2 (4.3)% was directed to the ipsilateral lung. This lung received only 16.5 (3.3)% of all the blood from sources of pulsatile blood flow. The blood flow to the lung at the side of BCPA accounted for 35.3 (1.7)% of the total pulmonary blood flow. CONCLUSIONS: Radionuclide angiocardiography allows the quantitative analysis of pulmonary blood supply in BCPA with sources of pulsatile blood flow except in patients with cavo-caval collaterals or bilateral BCPA. Non-pulsatile flow from BCPA is mainly directed to the ipsilateral lung, whereas pulsatile flow to the contralateral lung. Total perfusion of the ipsilateral lung is less than the perfusion of the contralateral lung.

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Selected References

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  1. Bargeron L. M., Jr, Karp R. B., Barcia A., Kirklin J. W., Hunt D., Deverall P. B. Late deterioration of patients after superior vena cava to right pulmonary artery anastomosis. Am J Cardiol. 1972 Aug;30(3):211–216. doi: 10.1016/0002-9149(72)90060-4. [DOI] [PubMed] [Google Scholar]
  2. Clarke C. P., Kahn D. R., Dufek J. H., Sloan H. The effects of nonpulsatile blood flow on canine lungs. Ann Thorac Surg. 1968 Nov;6(5):450–457. doi: 10.1016/s0003-4975(10)66052-3. [DOI] [PubMed] [Google Scholar]
  3. Cloutier A., Ash J. M., Smallhorn J. F., Williams W. G., Trusler G. A., Rowe R. D., Rabinovitch M. Abnormal distribution of pulmonary blood flow after the Glenn shunt or Fontan procedure: risk of development of arteriovenous fistulae. Circulation. 1985 Sep;72(3):471–479. doi: 10.1161/01.cir.72.3.471. [DOI] [PubMed] [Google Scholar]
  4. DeLeon S. Y., Ilbawi M. N., Idriss F. S., Muster A. J., Gidding S. S., Berry T. E., Paul M. H. Fontan type operation for complex lesions. Surgical considerations to improve survival. J Thorac Cardiovasc Surg. 1986 Dec;92(6):1029–1037. [PubMed] [Google Scholar]
  5. Furuse A., Brawley R. K., Gott V. L. Pulsatile cavo-pulmonary artery shunt. Surgical technique and hemodynamic characteristics. J Thorac Cardiovasc Surg. 1972 Mar;63(3):495–500. [PubMed] [Google Scholar]
  6. GORTEN R. J., STAUFFER J. C. A study of the techniques and sources of error in the clinical application of the external counting method of estimating cardiac output. Am J Med Sci. 1959 Sep;238:274–279. doi: 10.1097/00000441-195909000-00002. [DOI] [PubMed] [Google Scholar]
  7. Glenn W. W., Fenn J. E. Axillary arteriovenous fistula. A means of supplementing blood flow through a cava-pulmonary artery shunt. Circulation. 1972 Nov;46(5):1013–1017. doi: 10.1161/01.cir.46.5.1013. [DOI] [PubMed] [Google Scholar]
  8. Haller J. A., Jr, Adkins J. C., Worthington M., Rauenhorst J. Experimental studies on permanent bypass of the right heart. Surgery. 1966 Jun;59(6):1128–1132. [PubMed] [Google Scholar]
  9. Kirklin J. K., Blackstone E. H., Kirklin J. W., Pacifico A. D., Bargeron L. M., Jr The Fontan operation. Ventricular hypertrophy, age, and date of operation as risk factors. J Thorac Cardiovasc Surg. 1986 Dec;92(6):1049–1064. [PubMed] [Google Scholar]
  10. Kopf G. S., Laks H., Stansel H. C., Hellenbrand W. E., Kleinman C. S., Talner N. S. Thirty-year follow-up of superior vena cava-pulmonary artery (Glenn) shunts. J Thorac Cardiovasc Surg. 1990 Nov;100(5):662–671. [PubMed] [Google Scholar]
  11. Laks H., Mudd J. G., Standeven J. W., Fagan L., Willman V. L. Long-term effect of the superior vena cava-pulmonary artery anastomosis on pulmonary blood flow. J Thorac Cardiovasc Surg. 1977 Aug;74(2):253–260. [PubMed] [Google Scholar]
  12. Maltz D. L., Treves S. Quantitative radionuclide angiocardiography: determination of Qp: Qs in children. Circulation. 1973 May;47(5):1049–1056. doi: 10.1161/01.cir.47.5.1049. [DOI] [PubMed] [Google Scholar]
  13. Marcus M. L., Chilian W. M., Kanatsuka H., Dellsperger K. C., Eastham C. L., Lamping K. G. Understanding the coronary circulation through studies at the microvascular level. Circulation. 1990 Jul;82(1):1–7. doi: 10.1161/01.cir.82.1.1. [DOI] [PubMed] [Google Scholar]
  14. Marcus M. L., Chilian W. M., Kanatsuka H., Dellsperger K. C., Eastham C. L., Lamping K. G. Understanding the coronary circulation through studies at the microvascular level. Circulation. 1990 Jul;82(1):1–7. doi: 10.1161/01.cir.82.1.1. [DOI] [PubMed] [Google Scholar]
  15. Mayer J. E., Jr, Helgason H., Jonas R. A., Lang P., Vargas F. J., Cook N., Castaneda A. R. Extending the limits for modified Fontan procedures. J Thorac Cardiovasc Surg. 1986 Dec;92(6):1021–1028. [PubMed] [Google Scholar]
  16. Mazzera E., Corno A., Picardo S., Di Donato R., Marino B., Costa D., Marcelletti C. Bidirectional cavopulmonary shunts: clinical applications as staged or definitive palliation. Ann Thorac Surg. 1989 Mar;47(3):415–420. doi: 10.1016/0003-4975(89)90384-6. [DOI] [PubMed] [Google Scholar]
  17. McFaul R. C., Tajik A. J., Mair D. D., Danielson G. K., Seward J. B. Development of pulmonary arteriovenous shunt after superior vena cava-right pulmonary artery (Glenn) anastomosis. Report of four cases. Circulation. 1977 Jan;55(1):212–216. doi: 10.1161/01.cir.55.1.212. [DOI] [PubMed] [Google Scholar]
  18. Riihimäki E., Heiskanen A., Tähti E. Theory of quantitative determination of intracardiac shunts by external detection. Ann Clin Res. 1974 Feb;6(1):45–49. [PubMed] [Google Scholar]
  19. Salzer-Muhar U., Marx M., Ties M., Proll E., Wimmer M. Doppler flow profiles in the right and left pulmonary artery in children with congenital heart disease and a bidirectional cavopulmonary shunt. Pediatr Cardiol. 1994 Nov-Dec;15(6):302–307. doi: 10.1007/BF00798124. [DOI] [PubMed] [Google Scholar]
  20. Samánek M., Oppelt A., Kasalický J., Vorísková M. Distribution of pulmonary blood flow after cavopulmonary anastomosis (Glenn operation). Br Heart J. 1969 Jul;31(4):511–516. doi: 10.1136/hrt.31.4.511. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Slavik Z., Webber S. A., Lamb R. K., Horvath P., LeBlanc J. G., Keeton B. R., Monro J. L., Tax P., Tuma S., Reich O. Influence of bidirectional superior cavopulmonary anastomosis on pulmonary arterial growth. Am J Cardiol. 1995 Nov 15;76(14):1085–1087. doi: 10.1016/s0002-9149(99)80307-5. [DOI] [PubMed] [Google Scholar]

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