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Aortopulmonary collateral flow volume affects early postoperative outcome after Fontan completion: a multimodality study.
J Thorac Cardiovasc Surg. 2012 Dec; 144(6):1329-36.JT

Abstract

OBJECTIVE

Aortopulmonary collaterals are a frequent phenomenon in patients after bidirectional cavopulmonary connection. The aortopulmonary collateral flow volume can be quantified using cardiac magnetic resonance imaging. However, the significance of aortopulmonary collateral flow for the postoperative outcome after total cavopulmonary connection is unclear and was sought to be determined.

METHODS

The data from 33 patients were prospectively studied with cardiac magnetic resonance, echocardiography, and cardiac catheterization before the total cavopulmonary connection operation. The early postoperative outcomes after total cavopulmonary connection completion were recorded.

RESULTS

Aortopulmonary collateral flow was 1.59 L/min/m(2) ± 0.65 L/min/m(2) (range, 0.54 L/min/m(2)-3.34 L/min/m(2)), constituting 43% ± 13% (range, 12-87%) of pulmonary blood flow and 35% ± 12% (range, 11-62%) of the cardiac index, resulting in a pulmonary blood flow/systemic blood flow ratio of 1.06 ± 0.17 (range, 0.79-1.55). The aortopulmonary collateral flow correlated with pulmonary blood flow/systemic blood flow ratio (r = 0.69, P < .0001), oxygen saturation (r = 0.42, P = .018), and cardiac index (r = 0.53, P = .002). Of the 36 patients, 24 underwent fenestrated total cavopulmonary connection during the study period. The aortopulmonary collateral flow, relative to the cardiac index, correlated with the duration of hospital stay (r = 0.48, P = .02) and pleural drainage (r = 0.45, P = .03). Patients whose pleural drainage lasted 1 week or less had less aortopulmonary collateral flow before the Fontan operation than those with a longer period until chest tube removal (1.23 L/min/m(2) ± 0.38 L/min/m(2) vs 1.73 L/min/m(2) ± 0.76 L/min/m(2); P = .03). Compared with a contemporary group of total cavopulmonary connection patients with fenestration in their extracardiac conduit who were studied prospectively, with a similar protocol, the bidirectional cavopulmonary connection had a greater amount of aortopulmonary collateral flow (1.59 L/min/m(2) ± 0.65 L/min/m(2) vs 1.30 L/min/m(2) ± 0.57 L/min/m(2), P = .04).

CONCLUSIONS

Patients after bidirectional cavopulmonary connection routinely acquire a large amount of aortopulmonary collateral flow. The hemodynamic consequences of aortopulmonary collateral flow translate into adverse outcomes early after total cavopulmonary connection completion.

Authors+Show Affiliations

Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. lars.grosse-wortmann@sickkids.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22502974

Citation

Grosse-Wortmann, Lars, et al. "Aortopulmonary Collateral Flow Volume Affects Early Postoperative Outcome After Fontan Completion: a Multimodality Study." The Journal of Thoracic and Cardiovascular Surgery, vol. 144, no. 6, 2012, pp. 1329-36.
Grosse-Wortmann L, Drolet C, Dragulescu A, et al. Aortopulmonary collateral flow volume affects early postoperative outcome after Fontan completion: a multimodality study. J Thorac Cardiovasc Surg. 2012;144(6):1329-36.
Grosse-Wortmann, L., Drolet, C., Dragulescu, A., Kotani, Y., Chaturvedi, R., Lee, K. J., Mertens, L., Taylor, K., La Rotta, G., van Arsdell, G., Redington, A., & Yoo, S. J. (2012). Aortopulmonary collateral flow volume affects early postoperative outcome after Fontan completion: a multimodality study. The Journal of Thoracic and Cardiovascular Surgery, 144(6), 1329-36. https://doi.org/10.1016/j.jtcvs.2012.03.032
Grosse-Wortmann L, et al. Aortopulmonary Collateral Flow Volume Affects Early Postoperative Outcome After Fontan Completion: a Multimodality Study. J Thorac Cardiovasc Surg. 2012;144(6):1329-36. PubMed PMID: 22502974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aortopulmonary collateral flow volume affects early postoperative outcome after Fontan completion: a multimodality study. AU - Grosse-Wortmann,Lars, AU - Drolet,Christian, AU - Dragulescu,Andreea, AU - Kotani,Yasuhiro, AU - Chaturvedi,Rajiv, AU - Lee,Kyong-Jin, AU - Mertens,Luc, AU - Taylor,Katherine, AU - La Rotta,Gustavo, AU - van Arsdell,Glen, AU - Redington,Andrew, AU - Yoo,Shi-Joon, Y1 - 2012/04/13/ PY - 2012/01/12/received PY - 2012/02/24/revised PY - 2012/03/16/accepted PY - 2012/4/17/entrez PY - 2012/4/17/pubmed PY - 2013/1/23/medline SP - 1329 EP - 36 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 144 IS - 6 N2 - OBJECTIVE: Aortopulmonary collaterals are a frequent phenomenon in patients after bidirectional cavopulmonary connection. The aortopulmonary collateral flow volume can be quantified using cardiac magnetic resonance imaging. However, the significance of aortopulmonary collateral flow for the postoperative outcome after total cavopulmonary connection is unclear and was sought to be determined. METHODS: The data from 33 patients were prospectively studied with cardiac magnetic resonance, echocardiography, and cardiac catheterization before the total cavopulmonary connection operation. The early postoperative outcomes after total cavopulmonary connection completion were recorded. RESULTS: Aortopulmonary collateral flow was 1.59 L/min/m(2) ± 0.65 L/min/m(2) (range, 0.54 L/min/m(2)-3.34 L/min/m(2)), constituting 43% ± 13% (range, 12-87%) of pulmonary blood flow and 35% ± 12% (range, 11-62%) of the cardiac index, resulting in a pulmonary blood flow/systemic blood flow ratio of 1.06 ± 0.17 (range, 0.79-1.55). The aortopulmonary collateral flow correlated with pulmonary blood flow/systemic blood flow ratio (r = 0.69, P < .0001), oxygen saturation (r = 0.42, P = .018), and cardiac index (r = 0.53, P = .002). Of the 36 patients, 24 underwent fenestrated total cavopulmonary connection during the study period. The aortopulmonary collateral flow, relative to the cardiac index, correlated with the duration of hospital stay (r = 0.48, P = .02) and pleural drainage (r = 0.45, P = .03). Patients whose pleural drainage lasted 1 week or less had less aortopulmonary collateral flow before the Fontan operation than those with a longer period until chest tube removal (1.23 L/min/m(2) ± 0.38 L/min/m(2) vs 1.73 L/min/m(2) ± 0.76 L/min/m(2); P = .03). Compared with a contemporary group of total cavopulmonary connection patients with fenestration in their extracardiac conduit who were studied prospectively, with a similar protocol, the bidirectional cavopulmonary connection had a greater amount of aortopulmonary collateral flow (1.59 L/min/m(2) ± 0.65 L/min/m(2) vs 1.30 L/min/m(2) ± 0.57 L/min/m(2), P = .04). CONCLUSIONS: Patients after bidirectional cavopulmonary connection routinely acquire a large amount of aortopulmonary collateral flow. The hemodynamic consequences of aortopulmonary collateral flow translate into adverse outcomes early after total cavopulmonary connection completion. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/22502974/Aortopulmonary_collateral_flow_volume_affects_early_postoperative_outcome_after_Fontan_completion:_a_multimodality_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(12)00347-9 DB - PRIME DP - Unbound Medicine ER -