Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-28T02:06:44.113Z Has data issue: false hasContentIssue false
  • English
  • Français

The ratio of flow in the superior and inferior caval veins after construction of a bidirectional cavopulmonary anastomosis in children

Published online by Cambridge University Press:  18 April 2005

Benedicte Eyskens ,
Luc Mertens ,
Ronald Kuzo ,
Tom De Jaegere ,
John Lawrenson ,
Steven Dymarkowski ,
Jan Bogaert ,
Willem Daenen  and
Marc Gewillig
Benedicte Eyskens
Affiliation:
Department of Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
Luc Mertens
Affiliation:
Department of Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
Ronald Kuzo
Affiliation:
Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium
Tom De Jaegere
Affiliation:
Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium
John Lawrenson
Affiliation:
Department of Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
Steven Dymarkowski
Affiliation:
Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium
Jan Bogaert
Affiliation:
Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium
Willem Daenen
Affiliation:
Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium
Marc Gewillig
Affiliation:
Department of Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
Get access Rights & Permissions [Opens in a new window]

Abstract

In patients who have undergone a superior cavopulmonary anastomosis, the superior caval venous flow provides the only, or the most important, pulmonary blood supply, while the inferior caval venous blood is not oxygenated, being mixed with the pulmonary venous blood before entering the systemic circulation. In healthy children, the contribution of superior caval venous flow to total cardiac output has been shown to decrease during growth. Patients who have undergone a superior cavopulmonary anastomosis, however, often have a higher oxygen saturation than predicted by the age-matched ratio of superior to inferior caval venous flows. This study was designed, therefore, to assess the ratio of flows in the superior and inferior caval veins subsequent to a superior cavopulmonary anastomosis. We carried out 18 magnetic resonance imaging studies with velocity-mapping and heart catheterisations so as to assess the contribution of superior caval venous flow to total cardiac output. Patients were divided into 3 groups according to their age. There were five aged from 8 to 24 months, eight aged from 24 to 48 months, and five older than 48 months. No significant difference could be found in the ratios of superior-to-inferior caval venous flow, nor of superior caval venous-to-systemic flow, between the 3 groups. The ratio of venous flows was 0.89 ± 0.34 in those aged from 8 to 24 months, 1.09 ± 0.42 in those from 24 to 48 months, and 1.25 ± 0.27 in the older patients (F analysis of variance 1.06, p 0.37). The ratio of superior caval venous-to-systemic flow was 0.46 ± 0.08 in the youngest patients, 0.50 ± 0.09 in those aged from 24 to 48 months, and 0.55 ± 0.05 in the older patients (F analysis of variance 0.76, p 0.49). These findings suggest that the hemodynamics of a cavopulmonary anastomosis may affect the normal decrease of superior caval venous flow with age. This could be related to a redistribution of flow, with a proportionally higher flow to the head and upper body after construction of a superior cavopulmonary anastomosis. Since increasing cyanosis and progressive exercise intolerance are the main indications for creation of a total cavopulmonary connection, these findings should be taken into account when determining the timing for completion of the Fontan circulation.

Keywords

Magnetic resonance imagingvelocity mappingpulmonary flowchildren
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 2 , April 2003 , pp. 123 - 130
Copyright
© 2003 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This research was supported in part by a grant from the Belgian Foundation for Research in Pediatric Cardiology and by a grant from the Foundation for Scientific Research (Levenslijn FWO grant 7.0024.98). LM is a clinical researcher for the Fund for Scientific Research (FWO).

References

Alejos JC, Williams RG, Jarmakani JM, et al. Factors influencing survival in patients undergoing the bidirectional Glenn anastomosis. Am J Cardiol 1995; 75: 1048–1050.Google Scholar
Gewillig M, Kalis N. Pathophysiological aspects after cavopulmonary anastomosis. J Thorac Cardiovasc Surg 2000; 48: 1–6.Google Scholar
Mainwaring RD, Lambert JJ, Moore JW. The bidirectional Glenn and Fontan procedures – integrated management of the patient with a functionally single ventricle. Cardiol Young 1996; 6: 198–207.Google Scholar
Salim MA, Case CL, Sade RM, Watson DC, Alpert BS, diSessa TG. Pulmonary/systemic flow ratio in children after cavopulmonary anastomsis. J Am Coll Cardiol 1995; 25: 735–738.Google Scholar
Santamore WP, Barnea O, Riordan CJ, Ross MP, Austin EH. Theoretical optimization of pulmonary-to-systemic flow ratio after a bidirectional cavopulmonary anastomosis. Am J Physiol 1998; 274: 694–700.Google Scholar
Mohiaddin RH, Wann SL, Underwood R, Firmin DN, Rees S, Longmore DB. Vena caval flow: assessment with cine MR velocity mapping. Radiology 1990; 177: 537–541.Google Scholar
Salim MA, diSessa TG, Arheart KL, Alpert BS. Contribution of superior vena caval flow to total cardiac output in children. A Doppler echocardiographic study. Circulation 1995; 92: 1860–1865.Google Scholar
Gross GJ, Jonas RA, Castaneda AR, Hanley FL, Mayer JE, Bridges ND. Maturational and hemodynamic factors predictive of increased cyanosis after bi-directional cavopulmonary anastomosis. Am J Cardiol 1994; 74: 705–709.Google Scholar
Houlind K, Stenbog EV, Sorensen KE, et al. Pulmonary and caval flow dynamics after total cavopulmonary connection. Heart 1999; 81: 67–72.Google Scholar
Powell AJ, Geva T. Blood flow measurement by magnetic resonance imaging in congenital heart disease. Pediatr Cardiol 2000; 21: 47–58.Google Scholar
Rebergen SA, van der Wall EE, Doornbos J, de Roos A. Magnetic resonance measurement of velocity and flow: technique, validation and cardiovascular applications. Am Heart J 1993; 126: 1439–1456.Google Scholar
Frommelt MA, Frommelt PC, Berger S, et al. Does an additional source of pulmonary blood flow alter the outcome after a bidirectional cavopulmonary shunt? Circulation 1995; 92 (Suppl II): II: 240–244.Google Scholar
Mainwaring RD, Lamberti JJ, Uzark K, Spicer RL. Bidirectional flow. Is accessory pulmonary blood flow good or bad? Circulation 1995; 92 (Suppl II): II: 294–297.Google Scholar
Webber SA, Horvath P, LeBlanc JG, et al. Influence of competitive pulmonary blood flow on the bidirectional superior cavopulmonary shunt. A multi-institutional study. Circulation 1995; 92 (Suppl II): II: 279–286.Google Scholar
McElhinney DB, Reddy VM, Hanley FL, Moore P. Systemic venous collateral channels causing desaturation after bidirectional cavopulmonary anastomosis: evaluation and management. J Am Coll Cardiol 1997; 30: 817–824.Google Scholar
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; I: 307–310.Google Scholar
Fogel MA, Weinberg PM, Chin AJ, Fellows KE, Hoffman EA. Late ventricular geometry and performance changes of functional single ventricle throughout staged Fontan reconstruction assessed by magnetic resonance imaging. J Am Coll Cardiol 1996; 28: 212–221.Google Scholar
Kaulitz R, Luhmer I, Kallfelz HC. Pulsed Doppler echocardiographic assessment of patterns of venous flow after the modified Fontan operation: potential clinical implications. Cardiol Young 1998; 8: 54–62.Google Scholar
Kelley JR, Gary WM, Fahey JT. Diminished venous vascular capacitance in patients with univentricular hearts after the Fontan operation. Am J Cardiol 1995; 76: 158–163.Google Scholar