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Possible sources of right-to-left shunting in patients following a total cavopulmonary connection

Published online by Cambridge University Press:  19 August 2008

Gernot Buheitel ,
Michael Hofbeck ,
Ursula Tenbrink ,
Georg Leipold ,
Jürgen v.d. Emde  and
Helmut Singer
Gernot Buheitel*
Affiliation:
Department of Pediatric Cardiology and Department of Cardiovascular SurgeryUniversity Erlangen-Nürnberg, Germany
Michael Hofbeck
Affiliation:
Department of Pediatric Cardiology and Department of Cardiovascular SurgeryUniversity Erlangen-Nürnberg, Germany
Ursula Tenbrink
Affiliation:
Department of Pediatric Cardiology and Department of Cardiovascular SurgeryUniversity Erlangen-Nürnberg, Germany
Georg Leipold
Affiliation:
Department of Pediatric Cardiology and Department of Cardiovascular SurgeryUniversity Erlangen-Nürnberg, Germany
Jürgen v.d. Emde
Affiliation:
Department of Pediatric Cardiology and Department of Cardiovascular SurgeryUniversity Erlangen-Nürnberg, Germany
Helmut Singer
Affiliation:
Department of Pediatric Cardiology and Department of Cardiovascular SurgeryUniversity Erlangen-Nürnberg, Germany
*
Priv. Doz. Dr med. Gernot Buheitel, Universiteit Kinderklinik, Loschgestraáe 15, D-91054 Erlangen, Germany. Tel: 9131 3750; Fax: 9131 3113
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Abstract

Despite a good haemodynamic result, many children have amildly decreased arterial oxygen saturation following a total cavopulmonary connection. Our study was performed to determine possible mechanisms of right-to-left shunting in these patients. We performed elective cardiac catheterization in 19 children at a mean interval of 3.6 years following a total cavopulmonary connection. The intrapulmonary right-to-left shunt, the intracardiac right-to-left shunt and the total right-to-left shunt were calculated under mechanical ventilation with 100% oxygen. The intrapulmonary right-to-left shunt was 10.8±3.5% of the pulmonary blood flow, and the total right-to left shunt accounted for 18.9±5.2% of the systemic blood flow. The intracardiac right-to-left shunt in patients with no relevant venovenous collaterals or leaks in the atrial tunnel was calculated at 6.4±3.0% of the systemic blood flow, while the intracardiac right-to-left shunt in patients with relevant collaterials or leaks accounted for 13.0±5.9% of the systemic blood flow. Since intrapulmonary arteriovenous fistulas were not demonstrated angiographically in any of our patients, the intrapulmonary right-to-left shunt is probably due to low ratios of perfusion to ventilation in some pulmonary segments. The intracafdiac right-to-left shunt was due to leaks across the interatrial baffle, collaterals between stystemic and pulmonary veins, and to the coronary sinus draining to the pulmonary venous atrium.

Keywords

Total cavopulmonary connectionFontan operationright-to-left shuntcongenital heart disease
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 3 , July 1998 , pp. 358 - 363
Copyright
Copyright © Cambridge University Press 1998

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