This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tweddell, J. S. Search for Related Content PubMed PubMed Citation Articles by Tweddell, J. S. Related Collections Arterial thrombosis Coagulation Aggregation Platelet function inhibitors Pediatric and congenital heart disease, including cardiovascular surgery Platelets Other Vascular biology

(Circulation. 2007;116:236-237.)
© 2007 American Heart Association, Inc.

Editorial

Aspirin

A Treatment for the Headache of Shunt-Dependent Pulmonary Blood Flow and Parallel Circulation?

James S. Tweddell, MD

From the Children’s Hospital of Wisconsin and The Medical College of Wisconsin, Milwaukee.

Correspondence to James S. Tweddell, MD, Children’s Hospital of Wisconsin, 9000 W Wisconsin Ave, MS 715, Milwaukee, WI 53226. E-mail jtweddell@chw.org

Key Words: Editorials • aspirin • heart defects, congenital • platelets • shunts • thrombosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Dependence on an expanded polytetrafluoroethylene graft for provision of pulmonary blood flow is a common yet precarious interval through which a population of patients with congenital heart disease must pass. The goals of the systemic-to–pulmonary artery shunt are to relieve cyanosis and to provide time before establishing in-series circulation by either complete repair of 2-ventricle lesions or, in the case of the single-ventricle patient, a bidirectional Glenn shunt. In the case of patients with single-ventricle anatomy, this period of parallel circulation is necessary to permit the lung maturation and the reduction in pulmonary vascular resistance that are necessary for subsequent palliation. For patients who will ultimately achieve a 2-ventricle repair, the goals of a preliminary shunt may include increasing the size of the pulmonary artery size or having a larger, older patient at the time of repair. This period of parallel circulation is tenuous, and the patient remains at increased risk during this period of altered circulation.

Article p 293

With parallel circulation, cardiac output from the heart is partitioned to the lungs and body based on the relative resistances of the pulmonary and systemic circulations. If the shunt is large, the patient will experience excessive pulmonary blood flow and congestive heart failure. Furthermore, with a large shunt, diastolic pressure is low and coronary circulation may be impaired. With stress, autonomic reflexes will result in an acute increase in sympathetic tone. The elevation of systemic vascular resistance leads to acute increase in the ratio of pulmonary to systemic flow. In . . . [Full Text of this Article]