title: Influence of competitive pulmonary blood flow on the bidirectional superior cavopulmonary shunt. A multi-institutional study.
abstract: 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.
  
  
  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.
authors.affiliation: Division of Pediatric Cardiology, Wessex Cardiothoracic Centre, Southampton, England.
authors.forename: S A
authors.initials: SA
authors.lastname: Webber
authors.forename: P
authors.initials: P
authors.lastname: Horvath
authors.forename: J G
authors.initials: JG
authors.lastname: LeBlanc
authors.forename: Z
authors.initials: Z
authors.lastname: Slavik
authors.forename: R K
authors.initials: RK
authors.lastname: Lamb
authors.forename: J L
authors.initials: JL
authors.lastname: Monro
authors.forename: O
authors.initials: O
authors.lastname: Reich
authors.forename: J
authors.initials: J
authors.lastname: Hruda
authors.forename: G G
authors.initials: GG
authors.lastname: Sandor
authors.forename: B R
authors.initials: BR
authors.lastname: Keeton
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018610:Heart Bypass, Right / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010100:Oxygen / Q000097:blood; D010166:Palliative Care; D011183:Postoperative Complications; D011184:Postoperative Period; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010100:Oxygen