Maturational and hemodynamic factors predictive of increased cyanosis after bidirectional cavopulmonary anastomosis.
Bidirectional cavopulmonary anastomosis (BCA) is thought to be beneficial in the palliation of patients with univentricular congenital heart disease considered at high risk for Fontan repair. Experience with patients undergoing BCA suggested that those who were older or larger at the time of surgery tended to be more cyanotic postoperatively than their younger and smaller counterparts. This study was designed to identify correlates of systemic arterial oxygen saturation after BCA. Specifically, it was postulated that maturational changes in blood flow distribution might be associated with decreasing arterial oxygen saturation. Database records of all 110 patients undergoing BCA at our institution from June 1988 until the end of 1991 were reviewed. Postoperative catheterization data were available for 66 patients. Twenty-one patients were excluded because they had potentially reversible causes of cyanosis yielding inestimable degrees of error in hemodynamic calculations. In the remaining 45 patients, univariate and multivariate regression analyses were used to identify correlates of systemic arterial oxygen saturation. Growth and maturation as represented by body surface area exhibited a highly significant inverse correlation with arterial oxygen saturation (p = 0.005), as did pulmonary vascular resistance (p = 0.003). Patients who underwent BCA when > 3.9 years of age or with body surface area > 0.65 m2 were at significantly increased risk for excessive postoperative cyanosis, defined as systemic arterial oxygen saturation < or = 75% (p < 0.005). The interval between surgery and catheterization correlated directly with arterial oxygen saturation (p = 0.002), indicating a tendency toward earlier study of more cyanotic patients. None of the other variables examined correlated significantly with arterial oxygen saturation.(ABSTRACT TRUNCATED AT 250 WORDS)
Gross
G J
GJ
Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115.
Jonas
R A
RA
Castaneda
A R
AR
Hanley
F L
FL
Mayer
J E
JE
Bridges
N D
ND
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods; D001830:Body Surface Area; D002648:Child; D002675:Child, Preschool; D003490:Cyanosis / Q000503:physiopathology*; D005260:Female; D006128:Growth; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000601:surgery*; D011652:Pulmonary Circulation; D012044:Regression Analysis; D012189:Retrospective Studies; D014655:Vascular Resistance; D014683:Vena Cava, Superior / Q000601:surgery*
D010100:Oxygen