Mesenteric blood flow velocities in the newborn with single-ventricle physiology: Modified Blalock-Taussig shunt versus right ventricle-pulmonary artery conduit

Abstract

Postprandial retrograde diastolic flow was observed in the majority of patients palliated with an mBTS vs. none of the patients in the Sano group. However, contrary to expectations, postprandial mesenteric blood flow velocities in those palliated with an mBTS are significantly higher than in Sano patients, although the increase is not as high as that historically seen in normal neonates. This may place this population at risk for mesenteric ischemia and feeding intolerance in the postoperative period, and the risk may be even greater for those neonates palliated with a right ventricle-to-pulmonary artery conduit.

Celiac Artery Flow Pattern in Infants with Single Right Ventricle Following the Norwood Procedure with a Modified Blalock-Taussig or Right Ventricle to Pulmonary Artery Shunt

“…A modification to the classic Norwood procedure, involving a right ventricle to pulmonary artery shunt, has been shown to be associated with higher diastolic blood pressures compared to the modified Blalock–Taussig shunt [2, 5, 12-14, 18, 20, 21]. Several previous studies have evaluated mesenteric blood flow in patients with a modified Blalock–Taussig shunt and showed absent or reversed diastolic flow [4, 8, 9]. …”

“…A study by del Castillo and colleagues evaluated mesenteric flow in 27 single ventricle patients with a modified Blalock–Taussig shunt versus right ventricle to pulmonary artery shunt [8]. They found an increase in mesenteric blood flow velocities in postprandial patients with a modified Blalock–Taussig shunt that was not seen in patients with a right ventricle to pulmonary artery shunt [8].…”

“…The diastolic runoff present in the modified Blalock–Taussig shunt can be associated with impaired coronary artery and end-organ perfusion [12, 14, 18, 21]. Evaluation of mesenteric blood flow in patients with the modified Blalock–Taussig shunt to date has revealed reduced or retrograde diastolic blood flow but conflicting results regarding mesenteric vascular resistance, which is thought to be inversely related to gut perfusion [4, 8, 9, 22]. Mesenteric vascular resistance has not been previously evaluated in single ventricle patients with a right ventricle to pulmonary artery versus modified Blalock-Taussig shunt.…”

Asymptomatic malrotation: Diagnosis and surgical management

“…In patients with congenital heart disease, there are additional considerations compared to patients without heart disease. The studies included here addressed issues such as the timing of elective surgery with regard to cardiac palliation, the state of mesenteric blood flow in patients before and after various stages of cardiac palliation [37,38] and the definition of "symptomatic" in this complicated set of patients. Many cardiac patients cannot be considered asymptomatic because they frequently display signs of feeding intolerance that can mimic midgut volvulus.…”

Abnormal Abdominal Aorta Hemodynamics Are Associated With Necrotizing Enterocolitis in Infants With Hypoplastic Left Heart Syndrome

“…Finally, the role of post-operative feeding regimens and their link to NEC has recently been challenged [5]. Post-feeding resistance indices and flow velocities in the mesenteric arteries are abnormal in infants with HLHS regardless of shunt type [6]. This raises the possibility of abnormalities in the systemic vasculature of the neonate with HLHS that contribute to the development of NEC.…”