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Systemic ventricular size and performance before and after bidirectional cavopulmonary anastomosis
1Division of Cardiology, Children's Hospital Medical Center, Cincinnati, OH 45229.
Insights
Bidirectional cavopulmonary anastomosis (BCPA) effectively reduces ventricular size in pediatric heart patients before Fontan operation. This surgical approach helps maintain ventricular function while decreasing preload, improving outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiac Physiology
Background:
- Preoperative ventricular dilation is a risk factor for poor outcomes in patients undergoing Fontan operation.
- Bidirectional cavopulmonary anastomosis (BCPA) is proposed to reduce ventricular volume load and dilation, but this effect is not well-documented.
Purpose of the Study:
- To evaluate the effectiveness of BCPA in reducing systemic ventricular size.
- To assess if BCPA maintains ventricular function post-surgery.
Main Methods:
- Retrospective review of echocardiograms from 20 patients who underwent BCPA.
- Analysis of preoperative, early postoperative, and late follow-up echocardiograms.
- Measurements included end-diastolic and end-systolic areas, heart rate, and area shortening for ventricular size and function assessment.
Main Results:
- Indexed end-diastolic ventricular area significantly decreased after BCPA (26.2 cm²/m² to 21.4 cm²/m²).
- Ventricular function (area shortening) and heart rate remained unchanged.
- Patients with prior systemic-to-pulmonary shunts and those with left ventricular morphologic features showed a greater decrease in end-diastolic area.
Conclusions:
- BCPA significantly reduces systemic ventricular preload and size.
- Ventricular performance is maintained after BCPA.
- Prior palliation strategies and ventricular morphology influence the degree of ventricular size reduction following BCPA.
Abstract:
In patients eventually requiring Fontan operation, preoperative ventricular dilation is a risk factor for poor postoperative outcome. Bidirectional cavopulmonary anastomosis (BCPA) has been advocated to reduce ventricular volume load and decrease ventricular dilation; however, this effect has not been documented. To determine the effectiveness of this operation at reducing ventricular size while maintaining ventricular function, we reviewed preoperative and early postoperative echocardiograms in 20 patients undergoing BCPA. Ten of these patients also had later follow-up studies. Ventricular size was assessed by measurement of end-diastolic and end-systolic area, and heart rate was recorded at each study time. Ventricular function was assessed by area shortening. Indexed end-diastolic area was significantly smaller after BCPA than before (26.2 +/- 10.5 vs 21.4 +/- 6.5 cm2/m2). Area shortening and heart rate did not change significantly. Patients who had prior systemic-to-pulmonary shunts had a significant decrease in end-diastolic area after BCPA (30.2 +/- 12.2 vs 22.4 +/- 7.3 cm2/m2); those with prior pulmonary artery banding did not have a significant decrease (22.5 +/- 7.2 vs 19.9 +/- 6.5 cm2/m2). Patients with ventricles having left ventricular morphologic features had a significant decrease in end-diastolic area after BCPA (29.2 +/- 10.8 vs 22.8 +/- 6.5 cm2/m2); those with right ventricular morphologic features did not have a significant decrease (19.2 +/- 5.9 vs 18.0 +/- 5.9 cm2/m2). We conclude that BCPA results in a significantly reduced systemic ventricular preload and size while normal ventricular performance is maintained. Other factors such as prior palliation and ventricular morphologic features may affect the magnitude of the decrease in ventricular size seen after BCPA.