Bidirectional superior cavopulmonary anastomosis improves mechanical efficiency in dilated atriopulmonary connections

A. C. Lardo, S. A. Webber, A. Iyengar, P. J. Del Nido, I. Friehs, E. G. Cape

Research output: Contribution to journalArticle

Abstract

Objective: Few therapeutic options exist for patients with failing dilated atriopulmonary connections. We addressed the hypothesis that a bidirectional superior cavopulmonary anastomosis will improve the hemodynamic efficiency of dilated atriopulmonary connections while maintaining physiologic pulmonary flow distributions. Methods: Dilated atriopulmonary connections with and without a bidirectional superior cavopulmonary anastomosis were created in explanted sheep heart preparations and transparent glass models. A mechanical energy balance and flow visualization were performed for 6 flow rates (1-6 L/min), both with and without the bidirectional superior cavopulmonary anastomosis, and were then compared. A novel contrast echocardiographic technique was used to quantify inferior vena cava flow (hepatic venous return) distributions into the pulmonary arteries. Results: The rate of fluid-energy dissipation was 52% ± 14% greater in the dilated atriopulmonary anastomosis than in the bidirectional superior cavopulmonary anastomosis model over the range of flow rates studied (P = 6.3E-3). Total venous return passing to the right pulmonary artery increased from 41% ± 2% to 47% ± 3% (P = 9.7E-3) and that for inferior vena cava flow decreased from and 42% ± 3% to 12% ± 4% (P = 3.3E-4) after addition of the bidirectional superior cavopulmonary anastomosis. Flow visualization confirmed more ordered atrial flow in the bidirectional cavopulmonary anastomosis model, resulting from a reduction of caval flow stream collision and interaction. Conclusions: A bidirectional cavopulmonary anastomosis reduces fluid-energy dissipation in atriopulmonary connections, provides a physiologic distribution of total flow, and maintains some hepatic venous flow to each lung. This approach may be a technically simple alternative to atriopulmonary takedown procedures and conversions to total cavopulmonary connections in selected patients.

Original languageEnglish (US)
Pages (from-to)681-691
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume118
Issue number4
DOIs
StatePublished - 1999

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Right Heart Bypass
Inferior Vena Cava
Pulmonary Artery
Lung
Venae Cavae
Liver
Glass
Sheep
Hemodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Bidirectional superior cavopulmonary anastomosis improves mechanical efficiency in dilated atriopulmonary connections. / Lardo, A. C.; Webber, S. A.; Iyengar, A.; Del Nido, P. J.; Friehs, I.; Cape, E. G.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 118, No. 4, 1999, p. 681-691.

Research output: Contribution to journalArticle

Lardo, A. C. ; Webber, S. A. ; Iyengar, A. ; Del Nido, P. J. ; Friehs, I. ; Cape, E. G. / Bidirectional superior cavopulmonary anastomosis improves mechanical efficiency in dilated atriopulmonary connections. In: Journal of Thoracic and Cardiovascular Surgery. 1999 ; Vol. 118, No. 4. pp. 681-691.
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abstract = "Objective: Few therapeutic options exist for patients with failing dilated atriopulmonary connections. We addressed the hypothesis that a bidirectional superior cavopulmonary anastomosis will improve the hemodynamic efficiency of dilated atriopulmonary connections while maintaining physiologic pulmonary flow distributions. Methods: Dilated atriopulmonary connections with and without a bidirectional superior cavopulmonary anastomosis were created in explanted sheep heart preparations and transparent glass models. A mechanical energy balance and flow visualization were performed for 6 flow rates (1-6 L/min), both with and without the bidirectional superior cavopulmonary anastomosis, and were then compared. A novel contrast echocardiographic technique was used to quantify inferior vena cava flow (hepatic venous return) distributions into the pulmonary arteries. Results: The rate of fluid-energy dissipation was 52{\%} ± 14{\%} greater in the dilated atriopulmonary anastomosis than in the bidirectional superior cavopulmonary anastomosis model over the range of flow rates studied (P = 6.3E-3). Total venous return passing to the right pulmonary artery increased from 41{\%} ± 2{\%} to 47{\%} ± 3{\%} (P = 9.7E-3) and that for inferior vena cava flow decreased from and 42{\%} ± 3{\%} to 12{\%} ± 4{\%} (P = 3.3E-4) after addition of the bidirectional superior cavopulmonary anastomosis. Flow visualization confirmed more ordered atrial flow in the bidirectional cavopulmonary anastomosis model, resulting from a reduction of caval flow stream collision and interaction. Conclusions: A bidirectional cavopulmonary anastomosis reduces fluid-energy dissipation in atriopulmonary connections, provides a physiologic distribution of total flow, and maintains some hepatic venous flow to each lung. This approach may be a technically simple alternative to atriopulmonary takedown procedures and conversions to total cavopulmonary connections in selected patients.",
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AU - Friehs, I.

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N2 - Objective: Few therapeutic options exist for patients with failing dilated atriopulmonary connections. We addressed the hypothesis that a bidirectional superior cavopulmonary anastomosis will improve the hemodynamic efficiency of dilated atriopulmonary connections while maintaining physiologic pulmonary flow distributions. Methods: Dilated atriopulmonary connections with and without a bidirectional superior cavopulmonary anastomosis were created in explanted sheep heart preparations and transparent glass models. A mechanical energy balance and flow visualization were performed for 6 flow rates (1-6 L/min), both with and without the bidirectional superior cavopulmonary anastomosis, and were then compared. A novel contrast echocardiographic technique was used to quantify inferior vena cava flow (hepatic venous return) distributions into the pulmonary arteries. Results: The rate of fluid-energy dissipation was 52% ± 14% greater in the dilated atriopulmonary anastomosis than in the bidirectional superior cavopulmonary anastomosis model over the range of flow rates studied (P = 6.3E-3). Total venous return passing to the right pulmonary artery increased from 41% ± 2% to 47% ± 3% (P = 9.7E-3) and that for inferior vena cava flow decreased from and 42% ± 3% to 12% ± 4% (P = 3.3E-4) after addition of the bidirectional superior cavopulmonary anastomosis. Flow visualization confirmed more ordered atrial flow in the bidirectional cavopulmonary anastomosis model, resulting from a reduction of caval flow stream collision and interaction. Conclusions: A bidirectional cavopulmonary anastomosis reduces fluid-energy dissipation in atriopulmonary connections, provides a physiologic distribution of total flow, and maintains some hepatic venous flow to each lung. This approach may be a technically simple alternative to atriopulmonary takedown procedures and conversions to total cavopulmonary connections in selected patients.

AB - Objective: Few therapeutic options exist for patients with failing dilated atriopulmonary connections. We addressed the hypothesis that a bidirectional superior cavopulmonary anastomosis will improve the hemodynamic efficiency of dilated atriopulmonary connections while maintaining physiologic pulmonary flow distributions. Methods: Dilated atriopulmonary connections with and without a bidirectional superior cavopulmonary anastomosis were created in explanted sheep heart preparations and transparent glass models. A mechanical energy balance and flow visualization were performed for 6 flow rates (1-6 L/min), both with and without the bidirectional superior cavopulmonary anastomosis, and were then compared. A novel contrast echocardiographic technique was used to quantify inferior vena cava flow (hepatic venous return) distributions into the pulmonary arteries. Results: The rate of fluid-energy dissipation was 52% ± 14% greater in the dilated atriopulmonary anastomosis than in the bidirectional superior cavopulmonary anastomosis model over the range of flow rates studied (P = 6.3E-3). Total venous return passing to the right pulmonary artery increased from 41% ± 2% to 47% ± 3% (P = 9.7E-3) and that for inferior vena cava flow decreased from and 42% ± 3% to 12% ± 4% (P = 3.3E-4) after addition of the bidirectional superior cavopulmonary anastomosis. Flow visualization confirmed more ordered atrial flow in the bidirectional cavopulmonary anastomosis model, resulting from a reduction of caval flow stream collision and interaction. Conclusions: A bidirectional cavopulmonary anastomosis reduces fluid-energy dissipation in atriopulmonary connections, provides a physiologic distribution of total flow, and maintains some hepatic venous flow to each lung. This approach may be a technically simple alternative to atriopulmonary takedown procedures and conversions to total cavopulmonary connections in selected patients.

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