Summary
In total cavopulmonary connection (TCPC), the anastomotic portion of the caval veins to the pulmonary artery (PA) is decided empirically based on personal experience. To compare the pulmonary flow distribution from both caval veins in various types of cavopulmonary anastomosis, intrapulmonary ventilation-perfusion distribution after TCPC was studied using lung scanning. We studied 11 patients, 2 to 37 years old, at 30–84 months after TCPC. Lung scanning was performed by administering 185 MBq of xenon-133 saline solution from their upper extremities and, after xenon-133 was washed out, from their lower extremities. Radionuclide counts on both lungs were obtained and intrapulmonary ventilation-perfusion distribution was assessed. In 4 patients whose superior vena cava (SVC)-PA anastomosis was on the right side of the inferior vena cava (IVC)-PA anastomosis, the blood flow distribution of the right and left lungs was 57.4%: 42.6%. In 3 patients whose SVC-PA anastomosis was on the left side of the IVC-PA anastomosis, the blood flow distribution of the right and left lungs was equal in both lungs (right, 53.1%; left, 46.9%). Systemic arterial oxygen saturation increased after TCPC (before TCPC, 85.3% ± 2.7% and after TCPC, 89.8% ± 2.3% (P < 0.05) in group R; before TCPC, 86.1% ± 2.8% and after TCPC, 93.6% ± 0.6% (P < 0.02) in group L). After TCPC, the value in group L had a tendency to be greater than that in group R (P < 0.04), in spite of the same values of systemic arterial oxygen saturation before TCPC and cardiac index (group R, 2.9 ± 0.96; group L, 3.4 ± 0.37). Lung scanning with xenon-133 revealed the distribution of pulmonary blood flow in the patients after TCPC quantitatively, and in the patients whose SVC-PA anastomosis was on the left side of the IVC-PA anastomosis, the right and left balance of the pulmonary blood flow distribution appeared to be more balanced compared with patients whose connection was done the opposite way.
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de Leval MR, Kilner P, Gewillig M, Bull C (1998) Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. J Thorac Cardiovasc Surg 96:682–695
McElhinney DB, Reddy VM, Moore P, Hanley FL (1996) Revision of previous Fontan connections to extracardiac or intracardiac conduit cavopulmonary anastomosis. Ann Thorac Surg 62:1276–1283
Kao JM, Alejos JC, Grant PW, Williams RG, Shannon KM, Laks H (1994) Conversion of atriopulmonary to cavopulmonary anastomosis in management of late arrhythmias and atrial thrombosis. Ann Thorac Surg 58:1510–1514
de Leval MR, Dubini G, Migliaavacca F, Jalali H, Camporini G, Redington A, Pietrabissa R (1996) Use of computational fluid dynamics in the design of surgical procedures. Application to the study of competitive flows in cavopulmonary connections. J Thorac Cardiovasc Surg 111:502–513
Ohno K, Nakahara K, Hirose H, Nakano S, Kawashima Y (1987) Effects of valvular surgery on overall and regional lung function in patients with mitral stenosis. Chest 92:224–228
Matsushita T, Matsuda H, Ogawa M, Ohno K, Sano T, Nakano S, Shimazaki Y, Nakahara K, Arisawa J, Kozuka T, Kawashima Y, Yabuuchi H (1990) Assessment of the intrapulmonary ventilation-perfusion distribution after Fontan procedure for complex cardiac anomalies: relation to pulmonary hemodynamics. J Am Coll Cardiol 15:842–848
Fogel MA, Weinberg PM, Hoydu A, Hubbard A, Rychik J, Jacobs M, Fellows KE, Haselgrove J (1997) The nature of flow in the systemic venous pathway measured by magnetic resonance blood tagging in patients having the Fontan operation. J Thorac Cardiovasc Surg 114:1032–1041
Castellanos A, Hernandez FA (1967) The size of the right pulmonary artery in the normal subject and in congenital heart disease: angiocardiographic measurement. Am J Roentgenol 100:568–577
Ito T, Fukuda T, Suzuki T (1998) Assessment of the pulmonary ventilation-perfusion scintigram in patients who had Fontan operation. J Jpn Assn Thorac Surg 46: 325
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Tayama, M., Hirata, N., Matsushita, T. et al. Pulmonary blood flow distribution after the total cavopulmonary connection for complex cardiac anomalies. Heart Vessels 14, 154–160 (1999). https://doi.org/10.1007/BF02482300
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DOI: https://doi.org/10.1007/BF02482300