One and half ventricle repair: rationale, indications, and results

Talwar, Sachin; Siddharth, Bharat; Choudhary, Shiv Kumar; Airan, Balram

doi:10.1007/s12055-017-0628-5

Cited by 11 publications

(8 citation statements)

References 30 publications

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“…This phenomenon is in accordance with the qualitative results inferred from general cardiovascular physiology. Furthermore, the Plv/Prv of 1.5VR exceeded that of 2VR, which is consistent with the purpose of the 1.5VR surgery (Talwar et al, 2018). Considering the changing rates in the ventricular stroke work of the three surgical procedures, Plv and Ptotal of 1.0VR are more sensitive to variations in PVR, while Prv of 2VR is more sensitive to changes in PVR.…”

Section: Discussionsupporting

confidence: 73%

“…The one and a half ventricle repair (1.5VR) is widely applied in the treatment of congenital heart disease with abnormal structure and function of the right ventricle like the Pulmonary Atresia with Intact Ventricular Septum (PA with IVS) (Talwar et al, 2018;Wright et al, 2019), Tetralogy of Fallot (ToF) (Talwar et al, 2018) and Ebstein's Anomaly (EA) (Malhotra et al, 2018;Talwar et al, 2018;Akkaya et al, 2019). The operation consists of the bidirectional cavopulmonary shunt (BCPS) and the correction of the intracardiac malformation, and aims to make the right ventricle bear only blood flow of the lower body; thus, the sum of the left and right ventricle stroke work (Ptotal) won't change while the right ventricular volume load is reduced (Barron, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…The operation consists of the bidirectional cavopulmonary shunt (BCPS) and the correction of the intracardiac malformation, and aims to make the right ventricle bear only blood flow of the lower body; thus, the sum of the left and right ventricle stroke work (Ptotal) won't change while the right ventricular volume load is reduced (Barron, 2018). This operation maintains a low right atrial pressure, pulsating pulmonary blood flow and adequate blood oxygen during the short/medium term (Bhattarai et al, 2017;Talwar et al, 2018), which reduces the occurrence of poor prognosis such as the biventricular repair induced right heart failure (Talwar et al, 2018) and the single ventricular repair induced circulatory failure (Sharma et al, 2012;Talwar et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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Numerical Simulation of the Effect of Pulmonary Vascular Resistance on the Hemodynamics of Reoperation After Failure of One and a Half Ventricle Repair

Qiao

Yang

et al. 2020

Front. Physiol.

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Objective: The one and a half ventricle repair (1.5VR) is a common clinical choice for patients with right heart dysfunction. Considering the influence of blood circulation failure and reoperation in urgent need, this essay aims to explore the hemodynamic effects of different pulmonary vascular resistance (PVR) values on reoperation after 1.5VR failure. Methods: The lumped parameter model (LPM) was used to simulate the reoperation, including the return biventricular repair (2VR), ligation of azygos vein (1.5VR) and return single ventricular repair (1.0VR). Firstly, the debugging parameters were used to simulate the hemodynamics of 2VR. Secondly, the value of PVR was changed from one to four times while the other parameters remained unchanged. Finally, 15 cardiac cycles were simulated and the 15th result was obtained. In this work, the left and right ventricular stroke work and their sum (Plv, Prv, Ptotal), the left and right ventricular ejection fraction (LVEF, RVEF), the mean Cardiac Output (mCO) and the mean pressure and flow-rate ratio of superior and inferior vena cava (mPsvc\mPivc and mQsvc\mQivc), respectively, were used to describe the hemodynamics of reoperation. Results: With the change of PVR from one to four times, the values of Plv, Prv, Ptotal, LVEF, and RVEF gradually decreased. The change rate of Plv, Ptotal and LVEF of 1.0VR were the largest in the three kinds of reoperation. The change rate of Prv of 1.5VR was larger than that of 2VR, but it was the opposite for their EF change rate. The mCO of 2VR, 1.5VR , and 1.0VR decreased by 18.53%, 37.58%, and 48.07%, respectively. The mPsvc\mPivc of 1.5VR increased from 3.76 to 6.77 and the mQsvc\mQivc decreased from 0.55 to 0.36, while the mPsvc\mPivc and mQsvc\mQivc of 2VR and 1.0VR remained 1 and 0.67, respectively. The peak value of the tricuspid flow-rate (Qti) waveform of 2VR and 1.5VR changed from "E peak" to "A peak."

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Numerical Simulation of the Effect of Pulmonary Vascular Resistance on the Hemodynamics of Reoperation After Failure of One and a Half Ventricle Repair

Qiao

Yang

et al. 2020

Front. Physiol.

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“…BDG is applied in congenital heart disease with insufficient RV function. 4 BDG failure has several risk factors, such as pulmonary hypertension and elevated left atrial pressure. There was no evidence of pulmonary emboli or pulmonary hypertension in our patients, but all our patients had LV diastolic dysfunction before TV replacement.…”

Section: Discussionmentioning

confidence: 99%

Bidirectional Glenn shunt with tricuspid valve resection in patients with infective endocarditis

et al. 2022

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“…Як такий, ДКПА зменшує об'ємне навантаження на системний шлуночок і забезпечує адаптивний підхід на етапах лікування до та після процедури Фонтена [2,7]. З моменту свого заснування [3,6] техніка ДКПА змінилася, але не основна фізіологічна концепція. Потік із ВПВ завдяки своїй ефективності забезпечує легеневий кровотік та визначає сатурацію кисню в системному кровотоку.…”

Section: український журнал серцево-судинної хірургії 2021 3 (44)unclassified

Evaluation of Optimization of Pulmonary and Systemic Blood Flow in Children after Bidirectional Cavapulmonary Anastomosis

Dziuryi

Truba

Prokopovych

et al. 2021

ujcvs

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In patients after bidirectional cavapulmonary anastomosis, blood flow through the superior vena cava (SVC), providing effective pulmonary blood flow, is the most important factor influencing blood oxygen saturation. Blood flow through the inferior vena cava recirculates into the systemic bloodstream. The study of the ratio of these flows will provide better understanding of the physiology of blood circulation after anastomosis and determine systemic oxygen saturation of blood and optimal time to perform surgery. The aim. To determine volumetric blood flow in the SVC, calculate pulmonary to systemic blood flow ratio in children after bidirectional cavapulmonary anastomosis, and evaluate its contribution to cardiac output and oxygen saturation in systemic blood flow. Materials and methods. In the period from January 2010 to June 2021, 51 patients with congenital heart defects with depleted pulmonary blood flow underwent hemodynamic correction at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 29 male patients (57%) and 22 female patients (43%). The mean age of the patients at the time of the surgery was 34 ± 18.2 months (2 to 120 months), the mean age of patients at the time of examination was 43.5 ± 28.4 months (12 to 134 months). The main method of diagnosis in determining the defect and assessing the immediate and long-term results was echocardiographic examination and probing of the heart cavities. To evaluate the optimization of pulmonary/systemic blood flow we used equations obtained using the Fick method. Pulmonary to systemic blood flow ratio was calculated separately for 35 patients. Among the examined 35 patients, 18 children were older than 2.5 years, so all the examined patients were conveniently divided into 2 age groups: I group (n = 17) up to 2.5 years, II group (n = 18) older than 2.5 years to assess the contribution of SVC to the systemic circulation depending on age. Results. Pulmonary to systemic blood flow ratio was calculated for 35 patients Qp/Qs = (82% – 66%) / (97% – 66%) = 0.52. The calculated cardiac index according to echocardiography was 4.0 ± 0.85 L/min/m2 which corresponds to the SVC saturation (r = 0.60, p = <0.001). The flow in the superior vena cava = 2.08 L/min/m2. There was a very interesting trend towards decrease in the average rate of systemic saturation in patients after bidirectional cavapulmonary anastomosis depending on age and duration of surgery. Thus, in 17 patients of group I, the calculated Qp/Qs was (84% – 67%) / (97% – 67%) = 0.57. In patients of group II, the average systemic oxygen saturation was 78 ± 2% (from 65% to 81%). Calculated Qp/Qs for 18 patients of group II = (78% – 66%) / (97% – 66%) = 0.39, which indicates a decrease in pulmonary to systemic ratio with the growth of the child. Decreased systemic saturation after bidirectional cavapulmonary anastomosis in patients with increasing age and body surface area is associated with a decrease in the proportional flow from the superior vena cava. Therefore, in our clinical material, we confirmed the phenomenon of change in pulmonary to systemic ratio depending on age, which was described by Salim et al. according to a study conducted on healthy babies. Conclusions. The contribution of SVC flow to total cardiac output after bidirectional cavapulmonary anastomosis is directly associated with the patient’s age and gradually decreases in older patients, as indicated by a decrease in systemic saturation, so the clinical effect of bidirectional cavapulmonary anastomosis may be significantly better when performing surgery in early childhood.

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One and half ventricle repair: rationale, indications, and results

Cited by 11 publications

References 30 publications

Numerical Simulation of the Effect of Pulmonary Vascular Resistance on the Hemodynamics of Reoperation After Failure of One and a Half Ventricle Repair

Numerical Simulation of the Effect of Pulmonary Vascular Resistance on the Hemodynamics of Reoperation After Failure of One and a Half Ventricle Repair

Bidirectional Glenn shunt with tricuspid valve resection in patients with infective endocarditis

Evaluation of Optimization of Pulmonary and Systemic Blood Flow in Children after Bidirectional Cavapulmonary Anastomosis

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