This study reviewed the changes of hemodynamics and central pulmonary artery dimension in 54 patients who underwent bidirectional cavopulmonary shunt(BCPS) between February 1992 and December 1995 at Seoul National University Children's Hospital.
Age and
body weight of patients averaged 36.8±37.7 months and 8.0±3.0 kg, respectively, Eightynine percent of patients had more than 2 violations of the risk factors for Fontan operation, resulting overall hospital mortality of 16.6(9/54). Serial
hemodynamic
and angiographic examinations before and mean 16.3±14.3 months after BCPS were compared. The arterial oxygen saturation improved from a preoperative value of 71.9±10.1% to 79.8±8.5%(n=43, p<0.05). The values of arterial oxygen saturation were
lower
as the age of the patients with BCPS in place was older(n=22, R2=0.341, p=0.004). A mean pulmonary artery pressure and pulmonary vascular resistance reduced form 31±17 to 13.5±3.5mmHg(n=22, p<0.05) and from 3.2±2.1 to 2.3±2.7 unit(n=y,
p>0.05).
respectively. Follow-up study showed a significant increase of absolute values of ipsilateral pulmoanry artery(n=14, p<0.05), but no change of contralateral pulmonary artreries(n=14, p=not significant[NS]). However, there were significant
decreases
in
diameters of both ipsilateral and contralateral pulmonary arteries standardized by patients' body surface areas(16.8% decrease, n=14, p<0.05 for ipsilatreal, 25.1%, n=14, p<0.05 for contralateral). Pulmonary artery indices for cross sectional
areas
of
both pulmonary arterises decreased 9.3±13.8% with showing a trend of more decrease as the follow-up duration was longer. We conclude that the bidirectional cavopulmonary shunt provide an excellent mid-term palliation with good hemodynamic
improvements.
However, relative decreases in pulmonary artery dimesions in proportion to patients' growth may indicate an earlier subsequent Fontan repair.
|