Abstract 18380: Physiological Augmentation of Pulmonary Arterial Growth in Patients With Single Ventricle Physiology With Interim Selective Systemic to Pulmonary Arterial Shunt
Introduction: Stenosis or diffuse hypoplasia of central pulmonary arteries (PA) is common in patients with single ventricle physiology, often requiring surgical patching. Such repairs are prone to failure, particularly with low pressure venous flow (BCPC or Fontan). We describe our experience of disconnection of central pulmonary arteries and selective systemic-PA shunt to the hypoplastic vessel.
Methods: Single ventricle patients (n=12) with a diffuse LPA hypoplasia underwent PA disconnection (ligation clip) and selective arterial shunt to the LPA. Patients were considered, if there was ≤ mild AV valve regurgitation, and no more than mild systolic dysfunction on echo. Following systemic-LPA shunt, patients were re-assessed by cardiac catheterisation prior to further surgery, with follow-up catheterisation later performed.
Results: Increased volume loading was well tolerated with no increase in AV valve regurgitation and preserved systolic function. Selective arterial shunting increased the caliber of the LPA (baseline median 4.1mm (1.2-5.6); post shunt 6.5 (1.7-11.9)) and this increase was preserved post-Fontan (median 6.7mm (1.3-8.0)). As expected ventricular EDP was increased with arterial shunting but resolved after takedown of the shunt and Fontan completion. Post-Fontan hospital length of stay was not prolonged (median 11 days (7-14)).
Conclusion: In univentricular hearts and PA hypoplasia, selective systemic-PA shunting physiologically increases the caliber of the distal vessels. In selected patients this can be done safely with maintenance of PA growth and resolution of the elevated EDP with Fontan completion.
Author Disclosures: C. Seaman: None. Y. d’Udekem: None. B. Jones: None. C. Brizard: None. M.M. Cheung: None.
- © 2016 by American Heart Association, Inc.