Abstract:
OBJECTIVES:We sought to identify age-related differences in the ventricular response of patients after bidirectional cavopulmonary anastomosis (CPA) and to compare changes in the ventricular response among children < 3 years of age who underwent CPA with that of age-matched control subjects who had a systemic to pulmonary artery shunt alone. BACKGROUND:Pre-Fontan CPA has been advocated over a systemic to pulmonary artery shunt alone in patients with a single ventricle to facilitate ventricular volume unloading and minimize risk of the Fontan operation. METHODS:Our study evaluated 23 patients who initially received a systemic to pulmonary artery shunt as an initial procedure before subsequent Fontan palliation. In eight of these patients (group I), bidirectional CPA was performed before age 3 years, and in four (group II), it was performed after age 10 years. The remaining 11 patients (group III, age and weight control group for group I) were maintained with their initial shunt until they underwent Fontan palliation. Serial echocardiographic analysis was used retrospectively to evaluate left ventricular volume and mass and systolic pump function (ejection fraction) before and after bidirectional CPA. RESULTS:Through 10 months of follow-up, group I patients showed significant decreases in indexed end-diastolic volume both after CPA (120 ml/m1.5 body surface area vs. 78 ml/m1.5, p = 0.001) and in comparison with values in patients in group II and III, who showed no changes in end-diastolic volume (p < 0.001). Indexed ventricular mass decreased moderately after bidirectional CPA in group I (from 228 g/m1.5 body surface area to 148 g/m1.5) but remained unchanged in groups II and III. The differences in trends between groups I and III were significant (p = 0.03). Ejection fraction decreased significantly in group II versus group I patients (0.48 to 0.27 vs. 0.51 to 0.52, p < 0.05) after CPA. Oxygen saturation measurements before and after bidirectional CPA revealed a significant increase in group I (73% to 86%, p < 0.001) and a decrease in group II (82% to 73%, p < 0.01). CONCLUSIONS:Bidirectional CPA facilitates ventricular volume unloading and promotes regression of left ventricular mass in younger children (< 3 years) in preparation for a Fontan operation. In contrast, bidirectional CPA is of questionable value in older children as a staging procedure for Fontan palliation.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Forbes TJ,Gajarski R,Johnson GL,Reul GJ,Ott DA,Drescher K,Fisher DJdoi
10.1016/S0735-1097(96)00300-2subject
Has Abstractpub_date
1996-11-01 00:00:00pages
1301-7issue
5eissn
0735-1097issn
1558-3597pii
S0735-1097(96)00300-2journal_volume
28pub_type
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abstract::To determine whether long-term blood pressure levels correlate with left ventricular mass, echocardiographic measurements were performed in 152 men and 299 women who were participants in the Framingham Heart Study. All subjects were free of obesity and cardiovascular and pulmonary disease, were not taking antihyperten...
journal_title:Journal of the American College of Cardiology
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更新日期:2007-01-23 00:00:00
abstract::The environment in which the field of cardiology finds itself has been rapidly changing. This supplement, an expansion of a report created for the Board of Trustees, is intended to provide a timely snapshot of the socio-economic, political, and scientific aspects of this environment as it applies to practice both in t...
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journal_title:Journal of the American College of Cardiology
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doi:10.1016/s0735-1097(84)80178-3
更新日期:1984-05-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:1990-03-01 00:00:00
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pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2001-11-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2017-08-22 00:00:00
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doi:10.1016/j.jacc.2012.12.044
更新日期:2013-04-09 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jacc.2006.07.044
更新日期:2006-10-17 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1987-01-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0735-1097(87)80182-1
更新日期:1987-07-01 00:00:00
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pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2019.01.072
更新日期:2019-05-07 00:00:00
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pub_type: 杂志文章,meta分析
doi:10.1016/j.jacc.2009.07.062
更新日期:2010-01-19 00:00:00
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doi:10.1016/j.jacc.2004.09.047
更新日期:2005-01-04 00:00:00
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更新日期:2014-04-01 00:00:00
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更新日期:2015-01-20 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
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更新日期:2005-05-03 00:00:00
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更新日期:2010-02-23 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(10)80134-2
更新日期:1991-05-01 00:00:00
abstract::At present there is considerable activity in the area of prevention of atherosclerosis-related events using angiotensin-converting enzyme inhibitors. Large trials have demonstrated significant reduction in cardiovascular morbidity and mortality with long-term use of angiotensin-converting enzyme inhibitors in patients...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/0735-1097(95)00605-2
更新日期:1996-04-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(87)80427-8
更新日期:1987-11-01 00:00:00
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pub_type: 杂志文章
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更新日期:2000-09-01 00:00:00
abstract:OBJECTIVES:This study sought to examine whether plasma brain natriuretic peptide levels can predict prognosis after myocardial infarction. BACKGROUND:It has been suggested that concentrations of plasma brain natriuretic peptide reflect left ventricular function. Although the prognosis after myocardial infarction depen...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(96)00067-8
更新日期:1996-06-01 00:00:00
abstract:OBJECTIVE:To determine whether electron beam computed tomography (CT) adds to conventional risk factor assessment in the prediction of angiographic coronary artery disease. BACKGROUND:Electron beam CT scanning can be used to predict the severity of coronary atherosclerosis, but whether it does so independently of conv...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(98)00299-x
更新日期:1998-09-01 00:00:00
abstract::Coronary heart disease remains a major cause of morbidity and mortality in the United States, and its incidence is rising worldwide. Because atherosclerosis is a chronic process, and it is often associated with certain lifestyle and risk factors such as hypertension, dyslipidemia, and insulin resistance, much emphasis...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2011.02.027
更新日期:2011-06-07 00:00:00
abstract:OBJECTIVES:We assessed the frequency of abnormal forearm vasodilator responses during lower body negative pressure (LBNP) in 21 non-obstructive hypertrophic cardiomyopathy (HCM) patients (31 +/- 8 [20 to 43] years) with abnormal blood pressure response (ABPR) to exercise and the effects of three drugs used to treat vas...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.jacc.2005.05.053
更新日期:2005-09-06 00:00:00