Veno-venous bypass to prevent myocardial ischemia during right heart bypass operation in PA, IVS, and RV dependent coronary circulation

Asou, Toshihide; Matsuzaki, Kyosuke; Matsui, Kanji; Karl, Tom R.; Mee, Roger B.B.

doi:10.1016/s0003-4975(99)01527-1

Cited by 22 publications

(12 citation statements)

References 5 publications

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“…The technique used for construction of the Fontan procedure in patients with a right ventriculardependent coronary circulation may also be important. [132][133][134]153 Cardiopulmonary bypass unloads the right ventricle, and thus could compromise the supply of blood to the portion of the myocardium that is right ventricular-dependent. In order to obviate this situation, many are now performing an extracardiac Fontan procedure without cardiopulmonary bypass, thus hoping to prevent any adverse coronary arterial events.…”

Section: Postnatal Outcomementioning

confidence: 99%

“…In order to obviate this situation, many are now performing an extracardiac Fontan procedure without cardiopulmonary bypass, thus hoping to prevent any adverse coronary arterial events. [132][133][134]153 Interim mortality in staged reconstruction Interim mortality amongst patients with hypoplasia of the left heart syndrome undergoing staged univentricular palliation has been summarized elsewhere. 154 There is considerably less literature addressing interim mortality for patients with pulmonary atresia and intact ventricular septum, especially those undergoing functionally univentricular palliation.…”

Section: Postnatal Outcomementioning

confidence: 99%

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The significance of ventriculo-coronary arterial connections in the setting of pulmonary atresia with an intact ventricular septum

2005

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Section: Postnatal Outcomementioning

confidence: 99%

Section: Postnatal Outcomementioning

confidence: 99%

The significance of ventriculo-coronary arterial connections in the setting of pulmonary atresia with an intact ventricular septum

2005

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“…The consensus is that the heart should be kept full to avoid decompression of the right ventricle. [1][2][3] Anecdotally, this seems to work well for most surgeons and few would be willing to knowingly adopt a decompressive CPB strategy given the potential consequences. To our knowledge, the description by Asou and colleagues 1 of bicaval drainage and atrial infusion of oxygenated blood is perhaps the only report specifically directed at conduct of CPB.…”

Section: Discussionmentioning

confidence: 99%

Technique for myocardial protection in pulmonary atresia intact ventricular septum

Woods

2017

The Journal of Thoracic and Cardiovascular Surgery

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How to best protect the myocardium is a challenging situation that arises when a patient with pulmonary atresia intact ventricular septum (PA-IVS) and right ventricular dependent coronary circulation (RVDCC) requires an intracardiac procedure. We describe a simple, effective technique that addresses this problem. CLINICAL SUMMARY A premature (35 weeks) 2.1-kg male neonate with a diagnosis of PA-IVS was successfully resuscitated from cardiac arrest during coronary angiography that demonstrated RVDCC-right ostial atresia, circumflex, and distal left anterior descending coronary artery supplied by the right ventricle. Prior echocardiography had demonstrated multiple sinusoids, tortuous duct, diminutive right ventricle, and a tricuspid valve z score of À4.7. The patient was managed with prostaglandin E1 and beta blockade and listed status 1A for cardiac transplantation. The absence of a suitable donor organ, progressive desaturation, and acceptable pulmonary vascular resistance led to the decision to proceed to a Glenn procedure at age 3 months. Interval echocardiography demonstrated proximal left pulmonary artery stenosis and right-to-left bowing of the atrial septum with small interatrial communication. On the latter issue, a lengthy multidisciplinary discussion of the various options led to the plan of concomitant surgical septectomy.

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“…On the other hand, we used venoarterial CPB. In a previous report, venovenous bypass was shown to be useful to prevent myocardial ischemia during a right heart bypass operation in patients with PAIVS and RVDCC [9]. It is possible that venovenous bypass, draining systemic venous blood through cannulas inserted into the superior vena cava and inferior vena cava and perfusing the right atrium with oxygenated blood, can supply more oxygen to the coronary artery system than venoarterial bypass can supply.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of bidirectional cavopulmonary shunt in a patient with pulmonary atresia with intact ventricular septum associated with sinusoidal communications

et al. 2006

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Pulmonary atresia with intact ventricular septum (PAIVS) is sometimes associated with coronary artery anomalies, including right ventricle (RV)-to-coronary artery fistulas (sinusoidal communications), coronary artery stenoses, and coronary artery occlusions. In some cases, the coronary circulation depends entirely or partly on the desaturated systemic venous blood supply from the RV. Under these circumstances, decompression of the RV can result in fatal myocardial ischemia. A 6-month-old boy, diagnosed with PAIVS associated with sinusoidal communications, underwent a bidirectional cavopulmonary shunt procedure under venoarterial cardiopulmonary bypass (CPB). During CPB, to prevent RV decompression, we maintained right atrial pressure above 5 mmHg and used a pump perfusion rate of 30%-40% of the calculated value based on body surface area. Although electrocardiography showed slight ST depression and bradycardia, myocardial contractility after weaning from CPB was adequate to maintain the circulation with the administration of dobutamine and atrial pacing. In patients with PAIVS and RV-dependent coronary circulation, it is important to maintain coronary artery perfusion throughout the period of anesthesia.

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Veno-venous bypass to prevent myocardial ischemia during right heart bypass operation in PA, IVS, and RV dependent coronary circulation

Cited by 22 publications

References 5 publications

The significance of ventriculo-coronary arterial connections in the setting of pulmonary atresia with an intact ventricular septum

The significance of ventriculo-coronary arterial connections in the setting of pulmonary atresia with an intact ventricular septum

Technique for myocardial protection in pulmonary atresia intact ventricular septum

Anesthetic management of bidirectional cavopulmonary shunt in a patient with pulmonary atresia with intact ventricular septum associated with sinusoidal communications

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