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J Thorac Cardiovasc Surg 1994;107:1284-1290
© 1994 Mosby, Inc.
SURGERY FOR CONGENITAL HEART DISEASE |
Ann Arbor, Mich.
Dr. Mendelsohn is supported in part by NRSA HL08709-01, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
Presented in part at the Forty-second Scientific Sessions, American College of Cardiology, Anaheim, Calif., March 15-18, 1993.
Received for publication May 13, 1993. Accepted for publication Sept. 14, 1993. Address for reprints: Robert H. Beekman III, MD, FACC, Division of Pediatric Cardiology, University of Michigan Medical Center, MCHC F1310, Box 0204, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0204.
Abstract
The changes in pulmonary artery size and hemodynamics in 30 patients with univentricular cardiac anatomy were examined before and after bidirectional Glenn procedures done between October 1989 and February 1992. Serial angiographic and hemodynamic examinations before and 17.6 ± 1.6 months after bidirectional Glenn procedures were compared. At the follow-up study there was no significant change in diameter of the pulmonary artery ipsilateral to the bidirectional Glenn shunt; however, a significant decrease was noted in the diameter of the pulmonary artery contralateral to the bidirectional Glenn shunt (p = 0.04). There was also a 32% decrease in the Nakata index of total cross-sectional pulmonary artery area after the bidirectional Glenn procedure (p = 0.004). Total pulmonary blood flow and mean pulmonary artery pressure had decreased, and arterial oxygen saturation had increased at follow-up. These changes, however, did not correlate with the observed changes in pulmonary artery size. By linear regression analysis, a significant relationship was identified between the Nakata index before the bidirectional Glenn procedure and the absolute change in Nakata index (r = 0.83). A significant decrease in Nakata index occurred only in patients with a bidirectional Glenn shunt in place more than 15 months. Sixteen of the 30 patients subsequently underwent total cavopulmonary anastomosis with 7 requiring concurrent surgical pulmonary artery reconstruction. Changes in pulmonary artery size observed more than 15 months after the bidirectional Glenn procedure may have implications for subsequent Fontan repair in children with univentricular anatomy. (J THORACCARDIOVASCSURG1994;107:1284-90)
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