HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Doff B. McElhinney Frank L. Hanley Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Reddy, V. M. Articles by Hanley, F. L. Search for Related Content PubMed PubMed Citation Articles by Reddy, V. M. Articles by Hanley, F. L.

J Thorac Cardiovasc Surg 1996;112:1180-1192
© 1996 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

PULMONARY ARTERY GROWTH AFTER BIDIRECTIONAL CAVOPULMONARY SHUNT: IS THERE A CAUSE FOR CONCERN?

Received for publication May 6, 1996 Revisions requested June 25, 1996; revisions received August 7, 1996; Accepted for publication August 7, 1996. Address for reprints: V. Mohan Reddy, MD, 505 Parnassus Ave., M593, San Francisco, CA 94143-0118.

Abstract

Objective: Our objective was to analyze changes in pulmonary artery size after bidirectional cavopulmonary shunt. Methods: All 47 patients who underwent bidirectional cavopulmonary shunt between March 1990 and May 1995 who had preoperative and postoperative angiograms available for review were selected for study. This included 24 patients who had also undergone a modified Fontan operation. Clinical records were reviewed retrospectively and cross-sectional follow-up was obtained by direct physician contact. Angiograms were reveiwed, and the right and left pulmonary artery diameters were each measured at two locations: immediately distal to their origin and at the narrowest point. In addition, the lower lobe pulmonary artery branch was measured just distal to its origin. Cross-sectional areas (left, right, and total) at each point of measurement were indexed to body surface area. Angiographic and hemodynamic data were analyzed. Results: Changes in the various measures of pulmonary artery size after bidirectional cavopulmonary shunt varied considerably. On average the absolute diameters increased for all measures, but the increase in diameter was significant only for the lower lobe arteries. All pulmonary artery indices decreased on average, but these changes did not approach significance. Patients who underwent pulmonary artery augmentation at the time of bidirectional cavopulmonary shunt had significantly smaller pulmonary artery indices before pulmonary artery augmentation, relative to those who did not undergo pulmonary artery repair, and significantly greater changes (possibly to a large extent owing to pulmonary artery repair) in the right and left pulmonary artery index after bidirectionl cavopulmonary shunt. Lower lobe indices did not differ preoperatively or exhibit different degrees of change in size between patients who did and did not undergo pulmonary artery repair. One patient died after Fontan completion (pulmonary artery index: 305 mm²/m²), and none of the factors analyzed correlated with Fontan outcomes. Conclusions: A more appropriate measure of pulmonary artery growth is the indexed cross-sectional area of the lower lobe branch of the right and left pulmonary arteries, which is less likely to be altered surgically with systemic-pulmonary shunts, pulmonary artery repair, and the bidirectional cavopulmonary anastomosis itself. Pulmonary artery indices, including the lower lobe index, do not change significantly after bidirectional cavopulmonary shunt during medium-term follow-up and do not influence the Fontan outcome. (J THORACCARDIOVASCSURG1996;112:1180-92)

This article has been cited by other articles:

				C. Schreiber, J. Cleuziou, J. K. Cornelsen, J. Horer, A. Eicken, and R. Lange Bidirectional cavopulmonary connection without additional pulmonary blood flow as an ideal staging for functional univentricular hearts Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 550 - 555. [Abstract] [Full Text] [PDF]

				J. Cleuziou, C. Schreiber, J. K. Cornelsen, J. Horer, A. Eicken, and R. Lange Bidirectional cavopulmonary connection without additional pulmonary blood flow in patients below the age of 6 months Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 556 - 562. [Abstract] [Full Text] [PDF]

				S. Ovroutski and V. Alexi-Meskishvili Does the Nakata index predict outcome after Fontan operation? Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 951 - 951. [Full Text] [PDF]

				I. Adachi, H. Uemura, and T. Yagihara Reply to Ovroutski and Alexi-Meskishvili Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 951 - 952. [Full Text] [PDF]

				R. G. Gray, K. Altmann, R. S. Mosca, A. Prakash, I. A. Williams, J. M. Quaegebeur, and J. M. Chen Persistent Antegrade Pulmonary Blood Flow Post-Glenn Does Not Alter Early Post-Fontan Outcomes in Single-Ventricle Patients Ann. Thorac. Surg., September 1, 2007; 84(3): 888 - 893. [Abstract] [Full Text] [PDF]

				I. Adachi, T. Yagihara, K. Kagisaki, I. Hagino, T. Ishizaka, J. Kobayashi, S. Kitamura, and H. Uemura Preoperative small pulmonary artery did not affect the midterm results of Fontan operation Eur. J. Cardiothorac. Surg., July 1, 2007; 32(1): 156 - 162. [Abstract] [Full Text] [PDF]

				S. Sano New Era in Management of Hypoplastic Left Heart Syndrome Asian Cardiovasc Thorac Ann, April 1, 2007; 15(2): 83 - 85. [Full Text] [PDF]

				G H Tatum, G Sigfusson, J A Ettedgui, J L Myers, S E Cyran, H S Weber, and S A Webber Pulmonary artery growth fails to match the increase in body surface area after the Fontan operation Heart, April 1, 2006; 92(4): 511 - 514. [Abstract] [Full Text] [PDF]

				P. A. Berdat, E. Belli, F. Lacour-Gayet, C. Planche, and A. Serraf Additional Pulmonary Blood Flow Has No Adverse Effect on Outcome After Bidirectional Cavopulmonary Anastomosis Ann. Thorac. Surg., January 1, 2005; 79(1): 29 - 36. [Abstract] [Full Text] [PDF]

				S. Ovroutski, V. Alexi-Meskishvili, P. Ewert, J.-H. Nurnberg, R. Hetzer, and P.E. Lange Early and medium-term results after modified Fontan operation in adults Eur. J. Cardiothorac. Surg., March 1, 2003; 23(3): 311 - 316. [Abstract] [Full Text] [PDF]

				B. Xie, J. F. Zhang, and D. P. Shetty Bidirectional Glenn Shunt: 170 Cases Asian Cardiovasc Thorac Ann, September 1, 2001; 9(3): 196 - 199. [Abstract] [Full Text] [PDF]

				E. V. Potapov, V. V. Alexi-Meskishvili, I. Dahnert, E. A. Ivanitskaia, P. E. Lange, and R. Hetzer Development of pulmonary arteries after central aortopulmonary shunt in newborns Ann. Thorac. Surg., March 1, 2001; 71(3): 899 - 905. [Abstract] [Full Text] [PDF]

				V. Alexi-Meskishvili, S. Ovroutski, I. Dahnert, P. E. Lange, and R. Hetzer Early experience with extracardiac Fontan operation Ann. Thorac. Surg., January 1, 2001; 71(1): 71 - 76. [Abstract] [Full Text] [PDF]

				G. K.T. Iyer, G. S. Van Arsdell, F. P. Dicke, B. W. McCrindle, J. G. Coles, and W. G. Williams Are bilateral superior vena cavae a risk factor for single ventricle palliation? Ann. Thorac. Surg., September 1, 2000; 70(3): 711 - 716. [Abstract] [Full Text] [PDF]

				D. B. McElhinney, V. M. Reddy, W. Tworetzky, E. Petrossian, F. L. Hanley, and P. Moore Incidence and implications of systemic to pulmonary collaterals after bidirectional cavopulmonary anastomosis Ann. Thorac. Surg., April 1, 2000; 69(4): 1222 - 1228. [Abstract] [Full Text] [PDF]

				R. M. Freedom, D. Nykanen, and L. N. Benson The physiology of the bidirectional cavopulmonary connection Ann. Thorac. Surg., August 1, 1998; 66(2): 664 - 667. [Abstract] [Full Text] [PDF]

				D. B. McElhinney, S. M. Marianeschi, and V. M. Reddy Additional pulmonary blood flow with the bidirectional Glenn anastomosis: does it make a difference? Ann. Thorac. Surg., August 1, 1998; 66(2): 668 - 672. [Abstract] [Full Text] [PDF]

				Z SLAVIK and R FRANKLIN Changes in pulmonary artery size before and after total cavopulmonary connection Heart, August 1, 1998; 80(2): 208a - 209. [Full Text]