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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
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

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.

Type
Original Article
Copyright
© 2003 Cambridge University Press

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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).

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