Possible sources of right-to-left shunting in patients following a total cavopulmonary connection.
Despite a good haemodynamic result, many children have a mildly decreased arterial-oxygen saturation following a total cavopulmonary connection. Our study was performed to determine possible mechanisms of right-to-left shunting in these patients. We performed elective cardiac catheterization in 19 children at a mean interval of 3.6 years following a total cavopulmonary connection. The intrapulmonary right-to-left shunt, the intracardiac right-to-left shunt and the total right-to-left shunt were calculated under mechanical ventilation with 100% oxygen. The intrapulmonary right-to-left shunt was 10.8+/-3.5% of the pulmonary blood flow, and the total right-to-left shunt accounted for 18.9+/-5.2% of the systemic blood flow. The intracardiac right-to-left shunt in patients with no relevant venovenous collaterals or leaks in the atrial tunnel was calculated at 6.4+/-3.0% of the systemic blood flow, while the intracardiac right-to-left shunt in patients with relevant collaterals or leaks accounted for 13.0+/-5.9% of the systemic blood flow. Since intrapulmonary arteriovenous fistulas were not demonstrated angiographically in any of our patients, the intrapulmonary right-to-left shunt is probably due to low ratios of perfusion to ventilation in some pulmonary segments. The intracardiac right-to-left shunt was due to leaks across the interatrial baffle, collaterals between systemic and pulmonary veins, and to the coronary sinus draining to the pulmonary venous atrium.
Buheitel
G
G
Department of Pediatric Cardiology, University Erlangen-Nürnberg, Germany.
Hofbeck
M
M
Tenbrink
U
U
Leipold
G
G
vd Emde
J
J
Singer
H
H
D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D005260:Female; D018610:Heart Bypass, Right; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D010100:Oxygen / Q000097:blood; D011652:Pulmonary Circulation; D016896:Treatment Outcome
D010100:Oxygen