A Comparison of Bidirectional Glenn vs. Hemi-Fontan Procedure: An Analysis of the Single Ventricle Reconstruction Trial Public Use Dataset

Edelson, Jonathan B.; Ravishankar, Chitra; Griffis, Heather; Zhang, Xuemei; Faerber, Jennifer; Gardner, Monique M.; Naim, Maryam Y.; Macsio, Christopher E.; Glatz, Andrew C.; Goldberg, David J.

doi:10.1007/s00246-020-02371-6

Cited by 14 publications

(8 citation statements)

References 22 publications

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“…In some HLHS-specialized centers, the hemi-Fontan procedure is performed instead of the Glenn procedure, facilitating the connection of the superior vena cava to the pulmonary artery with a homograft patch, as opposed to a translocation of the artery to simplify the later Fontan operation [ 78 ]. To date, it has been established that the hemi-Fontan procedure is hardly associated with TR [ 79 ] and shows similar results to the Glenn in the short-term procedure [ 80 ]. Future long-term studies may further demonstrate the benefits or undesirable consequences of these Stage II procedures.…”

Section: Identified Indicators Of Tr In Hlhsmentioning

confidence: 99%

Tricuspid Valve Regurgitation in Hypoplastic Left Heart Syndrome: Current Insights and Future Perspectives

Ross

Mir

Burkhart

et al. 2023

JCDD

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Hypoplastic Left Heart Syndrome (HLHS) is a congenital heart defect that requires a three-stage surgical palliation to create a single ventricle system in the right side of the heart. Of patients undergoing this cardiac palliation series, 25% will develop tricuspid regurgitation (TR), which is associated with an increased mortality risk. Valvular regurgitation in this population has been extensively studied to understand indicators and mechanisms of comorbidity. In this article, we review the current state of research on TR in HLHS, including identified valvular anomalies and geometric properties as the main reasons for the poor prognosis. After this review, we present some suggestions for future TR-related studies to answer the central question: What are the predictors of TR onset during the three palliation stages? These studies involve (i) the use of engineering-based metrics to evaluate valve leaflet strains and predict tissue material properties, (ii) perform multivariate analyses to identify TR predictors, and (iii) develop predictive models, particularly using longitudinally tracked patient cohorts to foretell patient-specific trajectories. Regarded together, these ongoing and future efforts will result in the development of innovative tools that can aid in surgical timing decisions, in prophylactic surgical valve repair, and in the refinement of current intervention techniques.

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Section: Identified Indicators Of Tr In Hlhsmentioning

confidence: 99%

Tricuspid Valve Regurgitation in Hypoplastic Left Heart Syndrome: Current Insights and Future Perspectives

Ross

Mir

Burkhart

et al. 2023

JCDD

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“…Bidirectional cavopulmonary anastomosis (Glenn) is the second stage of hemodynamic correction of complex congenital heart disease with a single ventricle. When it is formed, blood is diverted from the superior vena cava basin to the pulmonary artery [5,6]. Rhodbard successfully bypassed the right ventricle by anastomosing the right atrial auricle with the pulmonary artery for the first time in 1948 (experiment on the dog heart).…”

Section: клінічна та експериментальна медицина / Clinical and Experim...mentioning

confidence: 99%

Experience of Anaesthetic Management and Intensive Care in Patients With Single Ventricle Physiology

Kalyta,

Dziuryi,

Boyko

et al. 2023

VPBM

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Вісник проблем біології і медицини -2023 -Вип. 4 (171) / Bulletin of problems in biology and medicine -2023 -Issue 4 (171) 199 КЛІНІЧНА ТА ЕКСПЕРИМЕНТАЛЬНА МЕДИЦИНА / CLINICAL AND EXPERIMENTAL MEDICINE2) a subgroup of "Ideal Hypertension" (n=125), which included people with hypertension according to both ESC/ ESH (2018) and ACC/AHA (2017) criteria;3) a subgroup of "Intermediate BP" (n=254), which included people with hypertension according to ACC/AHA criteria (2017) and "high norm" according to ESC/ESH criteria (2018).To determine the CVR, the following methods were used: PROCAM risk score; Framigham risk score based on lipid profile; Framigham risk score based on body mass index; QRISK 2 risk score; Pooled Cohort Equations risk score; ASCVD risk score.Results. The average values of the CVR level in the "Ideal Normotension" subgroup of the DM2 group were 8.5% (95% CI. 7.80; 9.28). In the "Intermediate BP" subgroup, this indicator corresponded to 12.9% (95% CI.12.32; 13.51), and in the subgroup of "Ideal hypertension" the value of cardiovascular risk was 18.0% (95% CI 17.43; 18.55). The differences between all subgroups were statistically highly significant: p <0.001.Conclusions. The use of CVR calculators both individually and in combination in patients in the DM2 group indicate that an increase in SBP to 130-139 mmHg and/or DBP to 80-89 mmHg contributed to an increase in cardiovascular risk. It can be assumed that a further increase in blood pressure further increases this risk.

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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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A Comparison of Bidirectional Glenn vs. Hemi-Fontan Procedure: An Analysis of the Single Ventricle Reconstruction Trial Public Use Dataset

Cited by 14 publications

References 22 publications

Tricuspid Valve Regurgitation in Hypoplastic Left Heart Syndrome: Current Insights and Future Perspectives

Tricuspid Valve Regurgitation in Hypoplastic Left Heart Syndrome: Current Insights and Future Perspectives

Experience of Anaesthetic Management and Intensive Care in Patients With Single Ventricle Physiology

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

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