Pulmonary blood distribution after total cavopulmonary connection of different types

To assess the feature of pulmonary blood flow distribution after total cavopulmonary connection (TCPC) of different types, and to provide the selection of the best type.

Thirty-two consecutive survival patients after TCPC underwent radionuclide lung perfusion imaging. According to the radionuclide counts in the left and right lungs, analyses of the distribution of blood flow from superior venous cava (SVC) and inferior venous cava (IVC) and the whole pulmonary blood flow in both lungs were made. All patients were divided into 4 groups by the the anastomosis between IVC and pulmonary artery.

Group I: The flow ratio of the IVC to left lung was greater than that to the right lung, P < or = 0.01; the flow ratio of the SVC to right lung was greater than that to the left lung, P < or = 0.01; and the whole pulmonary blood flow went dominantly to the left lung, P < or = 0.05, which is not in line with physiological distribution. Group II: the flows from the SVC and IVC were mixed in the middle of the junction and ran evenly into the right and left lungs, the whole pulmonay blood flow went to both lungs, P > or = 0.05. Group III: the flow ratio of the SVC to both lungs were the same, P > or = 0.05, and major part from IVC went to the right lung, P < or = 0.01; the pulmonary blood flow go dominantly to the right lung, P < or = 0.05, which is in accord with physiological distribution. Group IV: the flows from the right SVC went to right lung by 100%, P < or = 0.01, and that from the left SVC went to left lung by 100% too, P < or = 0.01; the flows from IVC went dominantly to the left lung, with little part to the right lung, P < or = 0.05.

Different types of TCPC can result in different pulmonary blood distributions. The best flow distribution between the left and right lungs can be obtained by an offset of the IVC anastomosis toward the RPA with widening anastomosis for the patients without persist left superior venous cava (PLSVC).