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The real fate of pulmonary arteries after bidirectional superior cavopulmonary anastomosis: is there a need for concern?

Published online by Cambridge University Press:  19 August 2008

Zdenek Slavik ,
Rodney C. G. Franklin  and
Rosemary Radley-Smith
Zdenek Slavik*
Affiliation:
Paediatric Surgical Unit, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Middlesex, UK
Rodney C. G. Franklin
Affiliation:
Paediatric Surgical Unit, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Middlesex, UK
Rosemary Radley-Smith
Affiliation:
Paediatric Surgical Unit, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Middlesex, UK
*
Z. Slavik MD, FRCP, Paediatric Surgical Unit, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Harefield, Middlesex UB9 6JH, UK. Tel/Fax: 01895 828554
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Abstract

Controversy remains about the growth of the pulmonary arteries following a bidirectional superior cavopulmonary anastomosis in children with complex cyanotic congenital cardiac malformations. This is partially due to the morphological heterogeneity of the patients, and partially due to methodological differences in series published so far. It is further complicated by the variable use, in different centres, of additional sources of pulmonary blood flow. We believe that the fate of these arteries preoperatively is significantly influenced by the amount of pulmonary blood flow and the initial size of the arteries. Separate assessment of the pulmonary arterial development postoperatively is recommended for those who, initially, had relatively small as opposed to larger than normal pulmonary arteries. Measurement of the diameters of both pulmonary arteries just prior to their first point of branching, together with the use of Z-score evaluation rather than the Nakata index, is discussed. It remains to be established whether, over time, the bidirectional cavopulmonary anastomosis is effective in developing adequately the pulmonary arteries in preparation for an ultimate total cavopulmonary connection, or even as isolated long-term palliation. A prospective, multi-institutional study involving sequential non-invasive assessment of pulmonary arterial development (using, for example, magnetic resonance imaging) is required to solve the outstanding problems.

Type
Review
Information
Cardiology in the Young , Volume 9 , Issue 1 , January 1999 , pp. 6 - 10
Copyright
Copyright © Cambridge University Press 1999

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References

1.Reddy, VM, Liddicoat, JR, Hanley, FL. Primary bidirectional superior cavopulmonary shunt in infants between 1 and 4 months of age. Ann Thorac Surg 1995; 59: 1120–1126.CrossRefGoogle ScholarPubMed
2.Slavik, Z, Lamb, RK, Webber, SA, Devlin, AM, Keeton, BR, Monro, JL, Salmon, AP. Bidirectional superior cavopulmonary anastomosis: how young is too young? Heart 1996; 75: 78–82.CrossRefGoogle Scholar
3.Reddy, VM, McElhinney, DB, Moore, P, Haas, GS, Hanley, FL. An institutional experience with the bidirectional cavopulmonary shunt: do we know enough about it? Cardiol Young 1997; 7: 284–293.CrossRefGoogle Scholar
4.Salmon, AP, Sethia, B, Silove, ED, Goh, D, Mitchell, I, Alton, H, DeGiovanni, JV, Wright, JGC, Abrams, LD. Cavopulmonary anastomosis as long-term palliation for patients with tricuspid atresia. Eur J Cardiothorac Surg 1989; 3: 494–498.CrossRefGoogle ScholarPubMed
5.Cochrane, AD, Brizard, CP, Penny, DJ, Johansson, S, Comas, JV, Malm, T, Karl, TR. Management of the univentricular connection: are we improving? Eur J Cardiothorac Surg 1997; 12: 107–115.CrossRefGoogle ScholarPubMed
6.Mazzera, E, Corno, A, Picardo, S, DiDonato, RM, Marino, B, Costa, D, Marcelletti, C. Bidirectional cavopulmonary shunts: Clinical application as staged or definitive palliation. Ann Thorac Surg 1989; 47: 415–420.CrossRefGoogle ScholarPubMed
7.Pridjan, AK, Mendelson, AM, Lupinetti, FM, Beekman, RH III, Dick, M II, Serwer, G, Bove, EL. Usefulness of bidirectional Glenn procedure as staged reconstruction for the functional single ventricle. Am J Cardiol 1993; 71: 959–962.CrossRefGoogle Scholar
8.Knott-Craig, CJ, Fryar-Dragg, T, Overholt, ED, Razook, JD, Ward, KE, Elkins, RC. Modified hemi-Fontan operation: An alternative definitive palliation for high-risk patients. Ann Thorac Surg 1995; 60: S554–557.CrossRefGoogle ScholarPubMed
9.Vargas, FJ, Mengo, G, Gallo, JP, Skerl, CB, Ranzzini, ME, Vazquez, JC. Bidirectional cavopulmonary shunt in patients with multiple risk factors. Ann Thorac Surg 1995; 60: S558–562.CrossRefGoogle ScholarPubMed
10.Fontan, F, Fernandez, G, Costa, F, Naftel, DC, Tritto, F, Blackstone, EH, Kirklin, JW. The size of the pulmonary arteries and the results of the Fontan operation. J Thorac Cardiovasc Surg 1989; 98: 711–724.CrossRefGoogle ScholarPubMed
11.Driscoll, DJ, Offord, KP, Feldt, RH, Schaff, HV, Puga, FJ, Danielson, GK. Five- to fifteen-year follow-up after Fontan operation. Circulation 1992; 85: 469–496.CrossRefGoogle ScholarPubMed
12.Reddy, VM, McElhinney, DB, Moore, P, Petrossian, E, Hanley, FL. Pulmonary artery growth after bidirectional cavopulmonary shunt: is there a cause for concern? J Thorac Cardiovasc Surg 1996; 112: 1180–1192.CrossRefGoogle Scholar
13.Mendelsohn, AM, Bove, EL, Lupinetti, FM, Crowley, DC, Lloyd, TR, Beekman, RH III. Central pulmonary artery growth pattern after the bidirectional Glenn ptocedure. J Thorac Cardiovasc Surg 1994; 107: 1284–1290.CrossRefGoogle Scholar
14.Waldman, JD, Karp, RB, Gittenberger-de-Groot, AC, Agarwala, B, Glagov, S. Spontaneous acquisition of discontinuous pulmonary arteries. Ann Thorac Surg 1996; 62: 161–168.CrossRefGoogle ScholarPubMed
15.Slavik, Z, Webber, SA, Lamb, RK, Horvath, P, LeBlanc, JG, Keeton, BR, Monro, JL, Tax, P, Tuma, S, Reich, O, Sandor, GGS, Daubeney, PEF, Salmon, AP. Influence of bidirectional superior cavopulmonary anastomosis on pulmonary arterial growth. Am J Cardiol 1995; 76: 1085–1087.CrossRefGoogle ScholarPubMed
16.Piehler, JM, Danileson, GK, McGoon, DC, Wallace, RB, Fulton, RE, Mair, DD. Management of pulmonary atresia with ventricular septal defect and hypoplastic pulmonary arteries by right ventricular outflow construction. J Thorac Cardiovasc Surg 1980; 80: 552–560.CrossRefGoogle ScholarPubMed
17.Nakata, S, Imai, Y, Takanashi, Y, Kurosawa, H, Tezuka, K, Nakazawa, M, Ando, M, Takao, A. A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart disease with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 1984; 88: 610–619.CrossRefGoogle ScholarPubMed
18.Kirklin, JW, Barratt-Boyes, BG. Anatomy, dimensions and terminology. In: Kirklin, JW, Barratt-Boyes, BG (eds). Cardiac Surgery, 2nd ed. Churchill Livingstone, New York, 1993: pp 3–60.Google ScholarPubMed
19.Uemura, H, Yagihara, T, Kawashima, Y, Okada, K, Kamiya, T, Anderson, R. Use of bidirectional Glenn procedure in the presence of forward flow from the ventricles to the pulmonary arteries. Circulation 1995; 92: 11228–232.CrossRefGoogle Scholar
20.Miyaji, K, Shimada, M, Sekiguchi, A, Ishizawa, A, Isoda, T. Usefulness of pulsatile bidirectional cavopulmonary shunt in high-risk Fontan patients. Ann Thorac Surg 1996; 61: 845–850.CrossRefGoogle ScholarPubMed
21.Reich, O, Horvath, P, Ruth, C, Krejcir, M, Skovranek, J. Pulmonary blood supply in bidirectional cavopulmonary anastomosis with pulsatile pulmonary blood flow: quantitative analysis using radionuclide angiocardiography. Heart 1996; 75: 513–517.CrossRefGoogle ScholarPubMed
22.Girod, DA, Rice, MJ, Mair, DD, Julsrud, PR, Puga, FJ, Danielson, GK. Relationship of pulmonary arterial size to mortality in patients undergoing the Fontan operation. Circulation 1995; 72: 1193–96.Google Scholar
23.Bridges, ND, Farell, PE, Pigott, JD, Norwood, WI, Chin, AJ. Pulmonary artery index: a nonpredictor of operative survival in patients undergoing modified Fontan repair. Circulation 1989; 80: I216–221.Google ScholarPubMed
24.Knott-Craig, CJ, Julsrud, PR, Schaff, HV, Puga, FJ, Danielson, GK. Pulmonary artery size and clinical outcome after the modified Fontan operation. Ann Thorac Surg 1993; 55: 646–651.CrossRefGoogle ScholarPubMed
25.Senzaki, H, Isoda, T, Ishizawa, A, Hishi, T. Reconsideration of criteria for the Fontan operation: influence of pulmonary artery size on postoperative hemodynamics of the Fontan operation. Circulation 1994; 89: 266–271.CrossRefGoogle ScholarPubMed
26.Webber, SA, Horvath, P, LeBlanc, JG, Slavik, Z, Lamb, RK, Monro, JL, Reich, O, Hruda, J, Sandor, GGS, Keeton, BR, Salmon, AP. Influence of competitive pulmonary blood flow on the bidirectional superior cavopulmonary shunt. A multi-institutional study. Circulation 1995; 92: II279–286.CrossRefGoogle ScholarPubMed
27.Knight, WB, Mee, RBB. A cure for pulmonary arteriovenous fistulas? Ann Thorac Surg 1995; 59: 999–1001.CrossRefGoogle ScholarPubMed
28.Vettukattill, JJ, Slavik, Z, Lamb, RK, Monro, JL, Keeton, BR, Gnanapragasam, JP, Tsang, VT, Aldous, AJ, Lewington, VJ, Salmon, AP. Intrapulmonary arteriovenous shunting is a universal phenomenon in patients with superior cavopulmonary shunts. A radionuclide study. Circulation 1996; 94: 1608.Google Scholar