HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

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 Add to Personal Folders Download to citation manager Author home page(s): Hikaru Matsuda Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kurotobi, S. Articles by Okada, S. Search for Related Content PubMed PubMed Citation Articles by Kurotobi, S. Articles by Okada, S. Related Collections Congenital - cyanotic

J Thorac Cardiovasc Surg 2001;121:1161-1168
© 2001 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Bidirectional cavopulmonary shunt with right ventricular outflow patency: The impact of pulsatility on pulmonary endothelial function

From the Department of Pediatrics and First Department of Surgery, Osaka University, Osaka, Japan.

Received for publication July 20, 2000. Revisions requested Sept 12, 2000; revisions received Sept 26, 2000. Accepted for publication Nov 14, 2000. Address for reprints: Shunji Kurotobi, MD, Department of Pediatrics, Toyonaka Municipal Hospital, 4-14-1, Shibahara-cho, Toyonaka City, Osaka, 560-8565, Japan.

Objective: Although in vitro studies have suggested the importance of flow pulsatility in endothelial function, few reports have focused on pulmonary endothelial function under decreased pulsatile flow after a bidirectional cavopulmonary shunt with or without an additional pulmonary flow source. The purpose of the present study was to assess the pulmonary endothelial function after bidirectional cavopulmonary shunt.
Methods and results: Pulmonary vasodilating response was evaluated in 10 patients 0.4 to 7.0 years (median 1.6 years) after bidirectional cavopulmonary shunt who were provided an additional flow source by retaining the pulmonary outflow tract and in 8 control subjects. Average pulmonary flow velocity was measured with a Doppler flow wire placed in the segmental lower lobe pulmonary artery during incremental infusion of acetylcholine (10^–8, 10^–7, 10^–6, and 10^–5 mol/L) and then of nitroglycerin (0.5 and 1.0 µg · kg^–1 · min^–1) after recovery. In the control subjects, a dose-dependent increase in flow velocity was observed in response to acetylcholine (maximum increase was 155% ± 17% of baseline) and to nitroglycerin (maximum increase was 151% ± 20% of baseline). In contrast, patients showed a significantly impaired response to acetylcholine (maximum increase was 124% ± 17% of baseline; P < .01 vs control), whereas the response to nitroglycerin was preserved (138% ± 12% of baseline; P = .09 vs control). In addition, the maximum response to acetylcholine correlated significantly with the pulmonary pulse pressure (r = 0.89, P < .01) and with the pulmonary flow pulsatility (r = 0.88, P < .01).
Conclusions: These results clearly suggest that patients after bidirectional cavopulmonary shunt show pulmonary endothelial functional attenuation and, of more importance, that decreased pulsatility of cavopulmonary flow is mainly responsible for this endothelial abnormality.

This article has been cited by other articles:

				B. E. Kogon, C. Plattner, T. Leong, J. Simsic, P. M. Kirshbom, and K. R. Kanter The bidirectional Glenn operation: A risk factor analysis for morbidity and mortality. J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1237 - 1242. [Abstract] [Full Text] [PDF]

				D. B. McElhinney and D. F. Teitel From Theory to Practice: Optimizing the Efficiency of an Inefficient Circulation Circulation, September 19, 2006; 114(12): 1226 - 1228. [Full Text] [PDF]

				Z. Yin, Z. Wang, H. Zhu, R. Zhang, H. Wang, and X. Li Experimental Study of Effect of Fontan Circuit on Pulmonary Microcirculation Asian Cardiovasc Thorac Ann, June 1, 2006; 14(3): 183 - 188. [Abstract] [Full Text] [PDF]

				C. D. Myers, J. H. Boyd, R. G. Presson Jr, P. Vijay, A. C. Coats, J. W. Brown, and M. D. Rodefeld Neonatal Cavopulmonary Assist: Pulsatile Versus Steady-Flow Pulmonary Perfusion Ann. Thorac. Surg., January 1, 2006; 81(1): 257 - 263. [Abstract] [Full Text] [PDF]

				C.-F. Lam, T. E. Peterson, A. J. Croatt, K. A. Nath, and Z. S. Katusic Functional adaptation and remodeling of pulmonary artery in flow-induced pulmonary hypertension Am J Physiol Heart Circ Physiol, December 1, 2005; 289(6): H2334 - H2341. [Abstract] [Full Text] [PDF]

				A. Ikai, M. Shirai, K. Nishimura, T. Ikeda, T. Kameyama, K. Ueyama, and M. Komeda Maintenance of pulmonary vasculature tone by blood derived from the inferior vena cava in a rabbit model of cavopulmonary shunt J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 199 - 206. [Abstract] [Full Text] [PDF]

				M. Chikada, A. Sekiguchi, H. Takayama, K. Tonari, A. Saito, and A. Ishizawa Usefulness of pulsatile bidirectional cavopulmonary shunt in high-risk fontan patients Ann. Thorac. Surg., September 1, 2002; 74(3): 971 - 972. [Full Text] [PDF]