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Aortopulmonary collateral flow volume affects early postoperative outcome after Fontan completion: a multimodality
Lars Grosse-Wortmann1, Christian Drolet, Andreea Dragulescu
1Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. lars.grosse-wortmann@sickkids.ca
The Journal of Thoracic and Cardiovascular Surgery
|April 17, 2012
Summary
Patients after bidirectional cavopulmonary connection develop significant aortopulmonary collateral flow. This increased flow is linked to adverse early outcomes following total cavopulmonary connection, impacting hospital stay and drainage duration.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Imaging
Background:
- Aortopulmonary collaterals are common after bidirectional cavopulmonary connection.
- Quantification of aortopulmonary collateral flow is possible with cardiac magnetic resonance imaging.
- The clinical significance of this collateral flow post-total cavopulmonary connection remains unclear.
Purpose of the Study:
- To determine the significance of aortopulmonary collateral flow for postoperative outcomes after total cavopulmonary connection.
- To investigate the correlation between aortopulmonary collateral flow and clinical parameters.
Main Methods:
- Prospective study of 33 patients undergoing total cavopulmonary connection.
- Data collected via cardiac magnetic resonance, echocardiography, and cardiac catheterization pre-operation.
- Early postoperative outcomes were recorded.
Main Results:
- Aortopulmonary collateral flow was substantial, averaging 1.59 L/min/m(2), comprising 43% of pulmonary blood flow.
- Increased collateral flow correlated with poorer outcomes, including longer hospital stays and pleural drainage.
- Patients with bidirectional cavopulmonary connection showed higher collateral flow compared to those with fenestrated extracardiac conduits.
Conclusions:
- Bidirectional cavopulmonary connection consistently leads to significant aortopulmonary collateral flow.
- The hemodynamic effects of this collateral flow contribute to adverse early outcomes after total cavopulmonary connection.
