Low preoperative superior vena cava blood flow predicts bidirectional cavopulmonary shunt failure

In Hospital Outcomes after Bidirectional Cavopulmonary Anastomosis: 18 Year Experience from a Single Center

“…2 Recently, cardiac magnetic resonance (CMR)-derived preoperative SVC blood flow has been shown to predict post BCPS physiology and clinical outcomes better than other anatomic and physiologic markers. 22 We believe, sometimes, we have performed BCPS in patients with elevated pulmonary vascular resistance; thereby these patients were doomed to failure or suffer early postoperative mortality. This might be one of reasons of our high mortality of 15%.…”

Reply from authors: Rescue bidirectional cavopulmonary shunt failure

“…The mortality associated with BCPS takedown is as high as 25% to 71.4% in the literature. 1,2 Perseveration of antegrade pulmonary blood flow may help borderline patients to maintain reasonable arterial saturation early after BCPS. The trade-off is that the antegrade blood flow causes some competing flow with the superior vena cava (SVC) flow, thereby potentially causing SVC syndrome.…”

“…Also, aortopulmonary collaterals (APC) flow is not insignificant in this population according to our cardiac magnetic resonance measurement. 1 The APC flow maybe maldistributed as well and could cause a significant retrograde flow to the affected lung, competing at SVC flow. Given that the pulmonary artery flow, APC flow, and pulmonary resistance could be substantially different between both lungs, adding an aortopulmonary shunt to the left of the BCPS may further compromise the BCPS physiology if the SVC-supplied right lung is mainly affected by pulmonary vascular abnormalities.…”

Commentary: The bidirectional Glenn procedure can be useful in palliating late‐presenting patients with complex cyanotic congenital heart disease

“…It is well established that BDG palliation based upon a comprehensive analysis derived by combining cardiac catheterization and preoperative MRI studies does not guarantee ideal results. 6,7 In the final analysis, we would like to know how the authors sorted out all of the patients presenting at their institution with worsening cyanosis in early childhood to select a cohort of patients that derived satisfactory short-term benefit from BDG palliation based solely upon clinical and echocardiographic data.…”

“…One of the messages implied by this report is that a sophisticated approach to preoperative testing before BDG procedure can result in satisfactory short‐term outcomes without the perceived need for diagnostic interventions requiring anesthesia and intubation, such as cardiac catheterization and MRI procedures. It is well established that BDG palliation based upon a comprehensive analysis derived by combining cardiac catheterization and preoperative MRI studies does not guarantee ideal results 6,7 . In the final analysis, we would like to know how the authors sorted out all of the patients presenting at their institution with worsening cyanosis in early childhood to select a cohort of patients that derived satisfactory short‐term benefit from BDG palliation based solely upon clinical and echocardiographic data.…”