Bidirectional cavopulmonary shunt with additional pulmonary blood flow: a failed or successful strategy?

Gerelli, Sébastien; Boulitrop, Célia; Steenberghe, Mathieu van; Maldonado, Davide; Bojan, Mirela; Raisky, Olivier; Sidi, Daniel; Vouhé, Pascal

doi:10.1093/ejcts/ezs053

Cited by 45 publications

(31 citation statements)

References 20 publications

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“…[75,78] These findings taken together support the hypothesis that the absence of hepatic venous blood flow and the lack of pulsatility act in concert to modify various angiogenesis pathways to stimulate PAVM development.…”

Section: Introductionsupporting

confidence: 59%

Pulmonary arteriovenous malformations after the superior cavopulmonary shunt: mechanisms and clinical implications

Kavarana

Jones

Stroud

et al. 2014

Expert Review of Cardiovascular Therapy

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Children with functional single ventricle heart disease are commonly palliated down a staged clinical pathway toward a Fontan completion procedure (total cavopulmonary connection). The Fontan physiology is fraught with long term complications associated with lower body systemic venous hypertension, eventually resulting in significant morbidity and mortality. The bidirectional Glenn shunt or superior cavopulmonary connection (SCPC) is commonly the transitional stage in single ventricle surgical management and provides excellent palliation. Some studies have demonstrated lower morbidity and mortality with the SCPC when compared with the Fontan. Unfortunately the durability of the SCPC is significantly limited by the development of pulmonary arteriovenous malformations (PAVMs) which have been commonly attributed to the absence of hepatic venous blood flow and the lack of pulsatile flow to the affected lungs. Abnormal angiogenesis has been suggested as a final common pathway to PAVM development. Understanding these fundamental mechanisms through the investigation of angiogenic pathways associated with the pathogenesis of PAVMs would help to develop medical therapies that could prevent or reverse this complication following SCPC. Such therapies could improve the longevity of the SCPC, potentially eliminate or significantly postpone the Fontan completion with its associated complications, and improve long-term survival in children with single ventricle disease.

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Section: Introductionsupporting

confidence: 59%

Pulmonary arteriovenous malformations after the superior cavopulmonary shunt: mechanisms and clinical implications

Kavarana

Jones

Stroud

et al. 2014

Expert Review of Cardiovascular Therapy

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“…Based on our results and current studies that investigated the effect of additional volume overload through aortopulmonary shunt implantation in BCPC-patients [20,21], it is unlikely that a mild or moderate amount of APC flow leads to myocardial dysfunction. However, a cut-off value for volume overload needs to be determined, that allows an optimal ventriculararterial coupling by matching pre-and afterload to maintain efficient myocardial performance in these patients [19].…”

Section: Discussionmentioning

confidence: 62%

Aortopulmonary Collateral Flow is Related to Pulmonary Artery Size and Affects Ventricular Dimensions in Patients After the Fontan Procedure

Latus¹,

Gummel²,

Diederichs³

et al. 2013

Thorac cardiovasc Surg

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Background: Aortopulmonary collaterals (APCs) are frequently found in patients with a single-ventricle (SV) circulation. However, knowledge about the clinical significance of the systemic-to-pulmonary shunt flow in patients after the modified Fontan procedure and its potential causes is limited. Accordingly, the aim of our study was to detect and quantify APC flow using cardiovascular magnetic resonance (CMR) and assess its impact on SV volume and function as well as to evaluate the role of the size of the pulmonary arteries in regard to the development of APCs.

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“…However, it was commonly opinion that bidirectional cavopulmonary anastomosis should be performed early in life in order to provide early volume unloading [13].Last but not least, the work did not investigate the long-term effect of systemic venous collaterals flow on patients because of retrospective design.…”

Section: Discussionmentioning

confidence: 99%

Analysis and Prediction of Collateral Channels from Left Superior Vena Cava after Bilateral Bidirectional Cavopulmonary Anastomosis

Si¹,

Qiao²,

Tong-jian³

et al. 2018

WJCD

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Objectives: To analyze and predict collateral channels in bilateral bidirectional cavopulmonary anastomosis focused on that from left superior vena cava. Methods: 41 consecutive patients who all underwent bilateral bidirectional cavopulmonary anastomosis were enrolled the study. The number, shape, size, origin and entry, and course of collateral vessels from left superior vena cava were referred for evaluation based on 41 cardiac angiographies. The influential factors on the formation of collateral vessels were identified by binary logistic regression analysis. Results: The number of the left superior vena cava with collateral vessels was larger than right one, 22 versus 8 (X 2 = 10.303, P = 0.001). The medium-distal parts of left systemic vena were prone to development of collateral channel. The logic function with respect to the probability of left systemic venous collateral channel could be expressed as the linear expression of left systemic venous pressure x: 0.418x − 7.111 (X 2 = 23.095, P < 0.001). Setting 17.0 mmHg of left systemic venous pressure as prediction cut-point to discriminate the occurrence of left collateral vessels, the predictive accuracy reached 85.7%. Conclusions: The left systemic venous pressure was an independent factor associated with left systemic venous collateral channel after bilateral bidirectional cavopulmonary shunt. It might be practically feasible to predict the development of collateral vessels according to systemic venous pressure.

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Bidirectional cavopulmonary shunt with additional pulmonary blood flow: a failed or successful strategy?

Cited by 45 publications

References 20 publications

Pulmonary arteriovenous malformations after the superior cavopulmonary shunt: mechanisms and clinical implications

Pulmonary arteriovenous malformations after the superior cavopulmonary shunt: mechanisms and clinical implications

Aortopulmonary Collateral Flow is Related to Pulmonary Artery Size and Affects Ventricular Dimensions in Patients After the Fontan Procedure

Analysis and Prediction of Collateral Channels from Left Superior Vena Cava after Bilateral Bidirectional Cavopulmonary Anastomosis

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