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(Circulation. 1995;92:279-286.)
© 1995 American Heart Association, Inc.

Articles

Influence of Competitive Pulmonary Blood Flow on the Bidirectional Superior Cavopulmonary Shunt

A Multi-Institutional Study

Steven A. Webber, MB, CHB; Pavel Horvath, MD; Jacques G. LeBlanc, MD; Zdenek Slavik, MD; Robert K. Lamb, FRCS; James L. Monro, FRCS; Oleg Reich, MD; Jaroslav Hruda, MD; George G.S. Sandor, MB, CHB; Barry R. Keeton, MB, BS; Anthony P. Salmon, MB, BS

From the Divisions of Pediatric Cardiology and Cardiothoracic Surgery, Wessex Cardiothoracic Centre, Southampton, England; the British Columbia Children's Hospital, Vancouver, Canada; and the Kardiocentrum, Prague, Czech Republic.

Correspondence to Dr S.A. Webber, Division of Cardiology, Children's Hospital of Pittsburgh, 3705 5th Ave, Pittsburgh, PA 15213.

Background It is common practice to interrupt all alternative sources of pulmonary blood flow ("competitive flow") at the time of a bidirectional superior cavopulmonary anastomosis (BCPA), although the merits of this have not been systematically studied.

Methods and Results We reviewed the early and medium-term clinical and hemodynamic findings in 108 consecutive patients 3 weeks to 25 years old (median, 1.9 years) undergoing BCPA at one of three institutions. Preoperatively, pulmonary blood flow was dependent on antegrade ventricular flow (n=50), systemic-to-pulmonary shunts (n=33), or mixed sources (n=25). Postoperatively, competitive sources of pulmonary blood flow were left patent in 43 of 108 patients (40%). There were four early (3.7%) and four late deaths, none related to persistence of competitive flow. After BCPA, patients with competitive flow had significantly higher systemic oxygen saturations at 1 hour (85% versus 79%), 24 hours (84% versus 78%), and at hospital discharge (84% versus 78%) and required a shorter period of artificial ventilation (median, 9 versus 24 hours) and intensive care (median, 2 versus 4 days). Oxygen saturations at late follow-up (median, 2.8 years; range, 1 to 7) did not differ (83% versus 82%). No patient developed pulmonary arteriovenous malformations.

Conclusions Competitive flow is well tolerated in the short and medium term after BCPA, and early postoperative systemic oxygen saturations are improved. The long-term influence of competitive flow on pulmonary arterial growth, arteriovenous malformation development, and ventricular function warrants investigation.

Key Words: blood flow • lung • shunts • anastomosis

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