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Changes in pulmonary artery size before and after total cavopulmonary connection
  1. Gernot Buheitela,
  2. Michael Hofbecka,
  3. Ursula Tenbrinka,
  4. Georg Leipolda,
  5. Jürgen von der Emdeb,
  6. Helmut Singera
  1. aDepartment of Paediatric Cardiology, University Children’s Hospital Erlangen, Erlangen, Germany, bDepartment of Cardiac Surgery, University Erlangen, Erlangen, Germany
  1. Dr Buheitel, Abteilung für Kinderkardiologie, Univ Kinderklinik, Loschgestr 15, D 91054 Erlangen, Germany.


Objective—To assess changes in size of the central pulmonary arteries following a total cavopulmonary connection (TCPC).

Design A retrospective analysis of the angiographic diameters of the central pulmonary arteries, expressed as z scores, in infancy before the TCPC and 3.5 (0.9) years (mean (SD)) later. Analysis of the relation between the pulmonary arteriolar resistance and the z scores at follow up.

Setting Tertiary referral centre.

Patients 32 patients who had TCPC from February 1990 to July 1993.

Results The patients were divided into two groups (n = 16) depending on their preoperative flow ratio: group I, Qp/Qs ⩽ 1; group II, Qp/Qs > 1. At the initial study in infancy the mean z scores in group I were −6.0 for the right pulmonary artery (RPA) and −9.6 for the left pulmonary artery (LPA); in group II the respective values were −2.7 and −3.0. Before the TCPC the values increased to 0.5 (RPA) and −0.5 (LPA) in group I, and to 8.8 (RPA) and 8.2 (LPA) in group II. At follow up the z scores decreased to −2.4 (RPA) and −4.9 (LPA) in group I, and to 2.2 (RPA) and −0.7 (LPA) in group II. The changes in pulmonary artery diameters were significant for both groups (p < 0.02). Following the TCPC, no significant difference in pulmonary arteriolar resistance index was found between patients with relatively small pulmonary arteries (z score RPA+LPA ⩽ 0) and those with relatively large pulmonary arteries (z score RPA+LPA > 0).

Conclusions Creation of a TCPC results in a significant reduction in size of the central pulmonary arteries. At a mean interval of 3.5 years following the TCPC, however, there was no significant difference in pulmonary arteriolar resistance index between patients with smaller and larger central pulmonary arteries.

  • total cavopulmonary connection
  • congenital heart disease
  • pulmonary artery size
  • pulmonary arteriolar resistance

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