Systemic to pulmonary collateral blood flow influences early outcomes following the total cavopulmonary connection

Odenwald, Tobias; Quail, Michael A.; Giardini, Alessandro; Khambadkone, Sachin; Hughes, Marina; Tann, Oliver; Hsia, Tain‐Yen; Muthurangu, Vivek; Taylor, Andrew M.

doi:10.1136/heartjnl-2011-301599

Cited by 61 publications

(41 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, we did not investigate the false positive cases (shunt detected by UD only) for the presence of extra cardiac shunts, which are common with some cardiac lesions [28,29]. Overall, the net effect may be to inflate the apparent false positive rate.…”

Section: Discussionmentioning

confidence: 92%

“…First, shunt flow may be significant, even in relatively small shunts, and also out of proportion to pressure gradients across chambers connected by the shunt [26,27]. Second, intra-and extra-cardiac shunts are not always apparent on echocardiography [2,3,28,29] and may need confirmation and quantification via alternative investigational modalities such as MRI or cardiac catheterization, which carry different risk profiles for the patient. Thus, UD may be a useful screening tool to evaluate patients who may need more detailed investigation.…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Accuracy of the transpulmonary ultrasound dilution method for detection of small anatomic shunts

Saxena

Krivitski

Peacock

et al. 2014

J Clin Monit Comput

View full text Add to dashboard Cite

The purpose of this study was to investigate the qualitative and quantitative accuracy of transpulmonary ultrasound dilution (UD) (COstatus™, Transonic Systems) for the detection of small anatomic shunts. It was a prospective, observational study in a multi-disciplinary pediatric intensive care unit. Seventy-three critically ill children (67 post cardiac surgery), with a median (IQR) age of 10 (3-50.3) months and a median (IQR) weight of 8 (3.43-13) kg were enrolled. Ultrasound dilution (UD) measurements were performed on patients within 1 h of undergoing two-dimensional echocardiography, which was used as the comparator technique. Shunt was diagnosed by characteristic changes on the UD curve shape, and was considered "test-positive" only if two or more measurements suggested the presence of the shunt. The UD technology also provided an estimate of pulmonary to systemic blood flow ratio (Qp:Qs). 12/73 (16.4 %) patients had a shunt identified by both UD and echocardiography. The overall accuracy (95 % CI) was 86.1 % (75.6-96.6 %), with a sensitivity of 85.7 % (57.2-98.2 %) and specificity of 86.4 % (75.0-94.0 %). The estimated Qp:Qs ranged from 0.7 to 1.4, which was consistent qualitatively with the echocardiographic findings on color flow doppler. Shunt was detected by UD alone in eight children; six of these had clinical conditions known to compromise dilution curve analysis (valve regurgitation, asymmetric pulmonary blood flow). Shunt was detected by echocardiography alone in two children; in both cases the shunt was tiny. UD is an accurate method for the detection of small anatomical shunts, both qualitatively and quantitatively.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Accuracy of the transpulmonary ultrasound dilution method for detection of small anatomic shunts

Saxena

Krivitski

Peacock

et al. 2014

J Clin Monit Comput

View full text Add to dashboard Cite

show abstract

“…Highlighting the clinical significance of APC flow, three studies recently demonstrated that increased collateral flow before the Fontan operation was associated with longer duration of pleural drainage and prolonged recovery in the postoperative period [6][7][8]. However, the mentioned studies primarily focused on technical aspects of quantifying APC flow [2][3][4] or were assessed in patients after the Glenn-procedure [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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.

show abstract

“…Several groups have identified systemic to pulmonary collateral flow as associated with poorer post-Fontan outcomes (Figure 3). [15][16][17] In our model, as the collateral flow increased from 0 to 1.4 L/min (equivalent of 2.5 L/min/m 2 ), the ratio of pulmonary flow to systemic flow (Qp/Qs) increased from 1.0 to 3.2 ( Figure 3, top two panels). The ventricular output (Qcor þ Qs þ Qcoll) increased to 29% (from 2.8 to 3.6 L/min/m 2 ) because the ''effective circulatory resistance'' seen by the single ventricle is reduced; however, Qs, in this case the systemic flow exclusive of the collaterals, dropped from 1.5 L/min to 0.6 L/min.…”

Section: Acute Valvular Regurgitationmentioning

confidence: 91%

Model-Based Comparison of the Normal and Fontan Circulatory Systems—Part II

Chin

Watrous

2015

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

show abstract

Systemic to pulmonary collateral blood flow influences early outcomes following the total cavopulmonary connection

Abstract: CMR can provide an effective measurement of SPC flow prior to TCPC. Young age at BCPC, high preoperative oxygen saturation and smaller PAs are associated with increased SPC flow, which may promote increased postoperative pleural drainage and lengthen recovery.

Cited by 61 publications

References 12 publications

Accuracy of the transpulmonary ultrasound dilution method for detection of small anatomic shunts

Accuracy of the transpulmonary ultrasound dilution method for detection of small anatomic shunts

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

Model-Based Comparison of the Normal and Fontan Circulatory Systems—Part II

Contact Info

Product

Resources

About