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

This Article Alert me when this article is cited Alert me if a correction is posted 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 Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Serraf, A. Articles by Planche, C. Search for Related Content PubMed PubMed Citation Articles by Serraf, A. Articles by Planche, C.

The Annals of Thoracic Surgery, Vol 58, 1096-1102, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

Pulmonary circulation evaluation before cavopulmonary connections: the cavopulmonary bypass

A Serraf, L Houyel, F Nicolas, F Lacour-Gayet, J Bruniaux, J Petit, MS Uva, D Roux and C Planche
Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Le Plessis-Robinson, France.

The outcome of Fontan-type procedures is dependent on several risk factors, among which pulmonary vascular resistances (PVRs) are an important component. Preoperative calculation of PVR entails several potential sources of error, particularly in patients with pulmonary atresia or multiple sources of pulmonary blood flow. In an attempt to develop a reliable test that accurately assesses the hemodynamic patterns of the pulmonary vascular bed before a Fontan procedure, a simulation of Fontan-type circulation was achieved in 13 patients by a partial cardiopulmonary bypass between the main pulmonary artery and both venae cavae (cavopulmonary bypass). During cavopulmonary bypass, pressures and resistances were recorded. Immediately after cavopulmonary bypass, the circulation was converted to standard cardiopulmonary bypass and the cavopulmonary connection was carried out. Preoperative pulmonary vascular resistance indexes were assessed roughly by the arteriovenous oxygen difference in systemic and pulmonary beds. There was no correlation between preoperative and perioperative calculations of pulmonary vascular resistance indexes (r = 0.24; p = not significant). Hemodynamic data available for all patients then were correlated to the early postoperative outcome assessed by a subjective four-point scale. A positive, significant correlation was found with intraoperative PVR (r = 0.90; p < 0.001), indexed PVR (r = 0.90; p < 0.001), and the pulmonary to systemic vascular resistance ratio (r = 0.98; p < 0.0001). Two of 13 patients had a 4-mm fenestration in the atrial baffle. No mortality or morbidity was related to the procedure. The absolute values of PVR and pulmonary vascular resistance indexes were strikingly higher than generally admitted for this type of procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				G. Szabo, V. Buhmann, A. Graf, S. Melnitschuk, S. Bahrle, C. F. Vahl, and S. Hagl Ventricular energetics after the Fontan operation: Contractility-afterload mismatch J. Thorac. Cardiovasc. Surg., May 1, 2003; 125(5): 1061 - 1069. [Abstract] [Full Text] [PDF]

				R. Aeba, T. Katogi, I. Kashima, T. Omoto, S. Kawada, and K. Omae Factors influencing arterial oxygenation early after bidirectional cavopulmonary shunt without additional sources of pulmonary blood flow J. Thorac. Cardiovasc. Surg., September 1, 2000; 120(3): 589 - 595. [Abstract] [Full Text] [PDF]