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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.
The Journal of Pediatrics
|June 1, 1993
Summary
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.