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Heart 1999;81:67-72; doi:10.1136/hrt.81.1.67
Copyright © 1999 BMJ Publishing Group Ltd & British Cardiovascular Society

Heart 1999;81:67-72 ( January )

Pulmonary and caval flow dynamics after total cavopulmonary connection

K Houlind,a E V Stenbøg,a K E Sørensen,b K Emmertsen,b O K Hansen,a L Rybro,c V E Hjortdala

a Department of Cardiothoracic and Vascular Surgery, Skejby Sygehus, Aarhus University Hospital, DK - 8200 Aarhus N, Aarhus, Denmark, b Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, c Department of Anaesthesiology, Skejby Sygehus, Aarhus University Hospital

Correspondence to: Dr Houlind. email: skejkh{at}aau.dk

Accepted for publication 29 July 1998

Objective---To assess flow dynamics after total cavopulmonary connection (TCPC).
Design---Cross-sectional study.
Setting---Aarhus University Hospital.
Patients---Seven patients (mean age 9 (4-18) years) who had previously undergone a lateral tunnel TCPC mean 2 (0.3-5) years earlier.
Interventions---Pressure recordings (cardiac catheterisation), flow volume, and temporal changes of flow in the lateral tunnel, superior vena cava, and right and left pulmonary arteries (magnetic resonance velocity mapping).
Results---Superior vena cava flow was similar to lateral tunnel flow (1.7 (0.6-1.9) v 1.3 (0.9-2.4) l/min*m2) (NS), and right pulmonary artery flow was higher than left pulmonary artery flow (1.7 (0.6-4.3) v 1.1 (0.8-2.5) l/min*m2, p < 0.05). The flow pulsatility index was highest in the lateral tunnel (2.0 (1.1-8.5)), lowest in the superior vena cava (0.8 (0.5-2.4)), and intermediate in the left and right pulmonary arteries (1.6 (0.9-2.0) and 1.2 (0.4-1.9), respectively). Flow and pressure waveforms were biphasic with maxima in atrial systole and late ventricular systole.
Conclusions---Following a standard lateral tunnel TCPC, flow returning via the superior vena cava is not lower than flow returning via the inferior vena cava as otherwise seen in healthy subjects; flow distribution to the pulmonary arteries is optimal; and some pulsatility is preserved primarily in the lateral tunnel and the corresponding pulmonary artery. This study provides in vivo data for future in vitro and computer model studies.

Keywords: blood flow dynamics;  total cavopulmonary connection;  congenital heart disease

© 1999 by Heart
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