Asymmetric distribution of the pulmonary blood flow between the right and left lungs in d-transposition of the great arteries

Muster, Alexander J.; Paul, Milton H.; Grondelle, Albertus van; Conway, James J.

doi:10.1016/0002-9149(76)90178-8

Cited by 44 publications

(21 citation statements)

References 19 publications

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“…By contrast, valid stroke volume determinations by Fick cardiac output methods require steady state conditions. Moreover, the limitations of these methods have not been rigorously evaluated in conditions where maldistribution of pulmonary blood flow is common postoperatively, such as in tetralogy of Fallot [51], transposition of the great arteries after atrial switch [32] and in complex congenital cardiac defects after Fontan correction [26].…”

Section: Discussionmentioning

confidence: 99%

Heart rate and oxygen uptake response to exercise in children with low peak exercise heart rate

1992

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Normal children achieve the same increase of oxygen uptake (VO2) in response to exercise even though resting and submaximal exercise heart rates vary greatly as a function of age, body size and physical conditioning. To determine whether the VO2 response to exercise is altered when heart rate is significantly reduced by heart disease, we compared 78 children who achieved a peak exercise heart rate of less than or equal to 150 beats/min to 201 controls of similar body size and normal peak exercise heart rates of greater than or equal to 180 beats/min. All performed incremental (16.4 Watts/min) maximal cycle exercise. Separate analysis of males and females included heart rate, power (kg-m/min, Watts/kg), VO2 (ml/min, ml/min per kg), O2 pulse (VO2/heart beat), VE (l/min) and R (VCO2/VO2) at rest and during the 1st, 4th and last minute of exercise. Patients with low peak exercise heart rates had also lower resting submaximal exercise heart rates than controls. VO2 at comparable exercise levels did not differ from controls and consequently O2 pulse was greater in the patients than controls at rest and at all levels of exercise. A consistent gender difference was only found in controls where males achieved a higher VO2 and lower heart rates at comparable levels of exercise. The data show a normal exercise VO2 despite significantly lower heart rates. These findings cannot be explained by an increased arteriovenous difference alone and suggest that the patients retained the ability to effectively modulate stroke volume.

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Section: Discussionmentioning

confidence: 99%

Heart rate and oxygen uptake response to exercise in children with low peak exercise heart rate

1992

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“…The direction of flow through the arterial duct was recorded throughout a cardiac cycle on cineangiogram. The preferential flow to RPA or LPA, if present, was also recorded on review of cineangiogram as reported previously [14]. …”

Section: Methodsmentioning

confidence: 99%

Morphologic Substrates for First-Branch Pulmonary Arterial Hypoplasia in Transposition of the Great Arteries

Chen

Wu²,

Chiu³

et al. 2007

Cardiology

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Background: Distal right-sided outflow obstruction remains a problem after arterial switch operation. We studied the anatomical features of the pulmonary trunk (PT) and its branches that are susceptible to right and left pulmonary arterial (RPA and LPA) hypoplasia in transposition of the great arteries (TGA). Methods: One hundred and one angiograms of TGA performed between 1981 and 1996 were viewed, and Polaroid photos were taken at end-systole. The diameters of RPA, LPA, PT, duct, ascending aorta, and angles between PA and PT were measured, and the ductal flow direction was recorded. Results: Forty-eight cases (47.5%) had a PA/PT diameter ratio (both PAs had same size) below 0.49. A smaller PA/PT was significantly related to posterior inclination of the proximal PT [narrower right (r = 0.50, p < 0.00001) and left (r = 0.48, p < 0.00001) PA-PT angle in lateral view] and a larger duct (r = 0.37, p < 0.0001). Eighteen patients had a follow-up angiogram after a mean period of 8.5 months. Those with a closed duct had evident PA growth (n = 12, 0.51 ± 0.09 to 0.74 ± 0.17, p < 0.0001), but four patients with an attenuated duct had no significant change (0.58 ± 0.06 to 0.68 ± 0.08, p = NS), and one with a persistent large duct had even regression of PA/PT (0.36–0.19). The direction of ductal flow was toward the aorta during early systole on cineangiogram. Conclusions: First-branch PA hypoplasia, which is frequently seen in TGA, was related to the right-to-left shunt through a duct resulting in hemodynamic starvation, and to posterior inclination of the proximal PT in this setting. Natural regression of the duct facilitated PA growth.

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“…The pattern of preferential blood flow to either lung can also change after surgical correction. 14,15 This change plays an important role in the development of shunts and pulmonary venous hypertension. In a single cohort of TGA patients with cavopulmonary shunts, two thirds developed subclinical pulmonary AV fistulas.…”

Section: Discussionmentioning

confidence: 99%

Improved Systemic Saturation after Ventricular Assist Device Implantation in a Patient with Decompensated Dextro-Transposition of the Great Arteries after the Fontan Procedure

Jabbar¹,

Franklin²,

Simpson³

et al. 2015

Texas Heart Institute Journal

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We report the successful implantation of a HeartMate II left ventricular assist device after a failed Fontan procedure in a patient with dextro-transposition of the great arteries. The patient had developed significant intrapulmonary arteriovenous shunting. Despite the theoretical risk of worsening intrapulmonary shunting due to the decrease in systemic vascular resistance after device implantation, our patient did well. He was discharged from the hospital in stable condition and had better oxygen saturation than before the device was implanted. To our knowledge, ours is the 2nd report of the use of a ventricular assist device after the failure of a Fontan procedure, and the first report concerning the effect of ventricular assist device implantation on intrapulmonary shunting.

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Asymmetric distribution of the pulmonary blood flow between the right and left lungs in d-transposition of the great arteries

Cited by 44 publications

References 19 publications

Heart rate and oxygen uptake response to exercise in children with low peak exercise heart rate

Heart rate and oxygen uptake response to exercise in children with low peak exercise heart rate

Morphologic Substrates for First-Branch Pulmonary Arterial Hypoplasia in Transposition of the Great Arteries

Improved Systemic Saturation after Ventricular Assist Device Implantation in a Patient with Decompensated Dextro-Transposition of the Great Arteries after the Fontan Procedure

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