Distribution of pulmonary blood flow after cavopulmonary anastomosis (Glenn operation).

Šamánek, M; Oppelt, A; Kasalický, J; Vorísková, M

doi:10.1136/hrt.31.4.511

Cited by 41 publications

(7 citation statements)

References 8 publications

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“…Patients who have undergone the Fontan procedure with or without a previous Glenn shunt for tricuspid atresia have a low pulsatile pulmonary blood flow. Perfusion studies in patients with Glenn shunts alone have shown this is associated with a maldistribution of pulmonary blood flow manifested by an increased distribution to the lower lung lobes (2)(3)(4)(5). In addition long term follow-up after Glenn shunts has revealed the development of pulmonary arteriovenous fistulae in the lower lobes (6).…”

Section: Discussionmentioning

confidence: 99%

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Cardiorespiratory Response to Exercise after the Fontan Procedure for Tricuspid Atresia

et al. 1988

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Noninvasive exercise testing was used to assess gas exchange in 13 patients age 6-25 yr who had undergone Fontan procedures for tricuspid atresia, five of whom had preexisting Glenn shunts. The results were compared to 28 age- and sex-matched controls. Oxygen saturation was measured by ear oximetry at rest and after exercise. Ventilation, oxygen consumption (VO2), carbon dioxide production (VCO2), and heart rate were measured during progressive exercise. The ventilatory equivalents for oxygen (VE/VO2) and carbon dioxide (VE/VCO2), mixed expired pCO2 (PECO2) end-tidal pCO2 (PETCO2), and dead space to tidal volume ratio (VD/VT) were determined during steady state exercise on a cycle ergometer. Heart rate was higher for VO2 by 15% (p less than 0.02) and ventilation was higher for both VO2 (by 37%, p less than 0.001) and VCO2 (by 27%, p less than 0.002) in the patients than the controls. Mean VE/VO2 was 35.4 +/- 7.8 (SD) compared to 25.8 +/- 3.1 (p less than 0.001) and mean VE/VCO2 was 41.7 +/- 9.0 compared to 31.6 +/- 4.3 (p less than 0.001). Mean PECO2 was 21.4 +/- 4.4 torr with controls at 27.9 +/- 3.8 (p less than 0.001) and mean PETCO2 was 33.0 +/- 5.3 torr compared to 40.0 +/- 3.3 (p less than 0.001). The patients had a mean oxygen saturation of 92 +/- 5% at rest and abnormal saturation after exercise (87 +/- 9, p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 99%

“…The patients had a mean oxygen saturation of 92 2 5% at with a similar hernodynamic picture (2)(3)(4)(5) as well as long-term rest and saturation after exercise (87 . ' ?, p evidence of the development of pulmonary arteriovenous fistulae 0.005)' There Were in Vn/Vo27 (6) in the lower lung lobes.…”

Section: F 44 Torrmentioning

confidence: 97%

Cardiorespiratory Response to Exercise after the Fontan Procedure for Tricuspid Atresia

et al. 1988

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“…The most popular amongst these for a number of years were absence of pulsatile pulmonary blood flow to the right lung, and dependent flow to the right lower lobe, reflected in a decreased ratio of perfusion between the upper and lower lobes. 24 This latter finding was thoroughly documented in 1969 by Samanek et al, 40 using a radioisotope technique, and then by others. Data about the incidence of the development of the malformations following the classical Glenn, bidirectional cavopulmonary anastomosis, Fontan operation or Kawashima-type of total cavopulmonary connection is conflicting.…”

Section: Pulmonary Arteriovenous Fistulas: Issues About Incidence Andmentioning

confidence: 76%

The biological “scrabble” of pulmonary arteriovenous malformations: considerations in the setting of cavopulmonary surgery

2004

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Pulmonary arteriovenous fistulas are vascular malformations, which, by virtue of producing abnormal vascular connections proximal to the units of gas exchange, result in intrapulmonary right-to-left shunting. These malformations or fistulas reflect at least in part disordered angiogenesis, and less commonly recruitment and dilation of pre-existing vascular channels. Pulmonary arteriovenous fistulas occur in a number of diverse clinical settings. Such fistulas are a well-established feature of the Weber-Osler-Rendu complex, or hereditary haemorrhagic telangiectasia, an autosomal dominant vascular dysplasia characterized by mucocutaneous telangiectasis, epistaxis, gastrointestinal haemorrhage, and arteriovenous malformations in the lung, brain, liver and elsewhere. They are also seen in the patient with acute or chronic liver disease, disease that is usually but not invariably severe, or those with non-cirrhotic portal hypertension. They may occur as congenital malformations, single or diffuse, large or small in isolation, and when large or extensive enough may result in hypoxaemia, clinical cyanosis, and heart failure. Cerebral vascular accidents are also a well-known complication of this disorder. An extensive literature has accumulated with regard to the pulmonary arteriovenous fistulas seen in the setting of the Weber-Osler-Rendu complex, and there is considerable information on the genetics, basic biology, clinical findings, complications and therapeutic interventions of these malformations in the setting of this syndrome. These issues, however, are not the primary considerations of this review, although some aspects of this fascinating disorder will be discussed later. Rather the focus will be on pulmonary arteriovenous malformations that develop in the setting of cavopulmonary surgery, and their relationship to the pulmonary arteriovenous fistulas occurring in the hepatopulmonary syndrome. The complex tapestry of these overlapping and intersecting clinical observations will be unfolded in the light of their chronology.

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“…Some authors reported beneficial effects of pulsatile flow for the pulmonary circulation and respiratory function (61–65), while other authors could not confirm these results (60,66,67). Furthermore, in patients, abnormal distribution of pulmonary blood flow has been observed after the Glenn or Fontan operations (68–70). Such results suggest that nonpulsatile blood flow may affect the pulmonary microvascular circulation.…”

Section: Pulsatile Versus Nonpulsatile For Pulmonary Circulationmentioning

confidence: 99%

Right Ventricular Failure After Left Ventricular Assist Device Implantation: The Need for an Implantable Right Ventricular Assist Device

2005

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Right ventricular failure after implantation of a left ventricular assist device is an unremitting problem. Consideration of portal circulation is important for reversing liver dysfunction and preventing multiple organ failure after left ventricular assist device implantation. To achieve these objectives, it is imperative to maintain the central venous pressure as low as possible. A more positive application of right ventricular assistance is recommended. Implantable pulsatile left ventricular assist devices cannot be used as a right ventricular assist device because of their structure and device size. To improve future prospects, it is necessary to develop an implantable right ventricular assist device based on a rotary blood pump.

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Distribution of pulmonary blood flow after cavopulmonary anastomosis (Glenn operation).

Cited by 41 publications

References 8 publications

Cardiorespiratory Response to Exercise after the Fontan Procedure for Tricuspid Atresia

Cardiorespiratory Response to Exercise after the Fontan Procedure for Tricuspid Atresia

The biological “scrabble” of pulmonary arteriovenous malformations: considerations in the setting of cavopulmonary surgery

Right Ventricular Failure After Left Ventricular Assist Device Implantation: The Need for an Implantable Right Ventricular Assist Device

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