title: Appropriate additional pulmonary blood flow at the bidirectional Glenn procedure is useful for completion of total cavopulmonary connection.
abstract: BACKGROUND
  The role and effect of additional pulmonary blood flow at the time of bidirectional Glenn procedure (BDG) is controversial. We assessed our experiences to clarify the effects of controlled additional pulmonary blood flow on outcomes after BDG.
  
  
  METHODS
  Thirty-eight patients who underwent BDG (2.1 +/- 2.1 years of age) were enrolled in this study. In group A (n = 29) additional pulmonary blood flow was controlled by the banding of the pulmonary trunk, or the previously created Blalock-Taussig shunt, to keep the central venous pressure equal to or less than 16 mm Hg at BDG. In group B (n = 9), BDG was the only source of pulmonary blood flow.
  
  
  RESULTS
  One operative death occurred in group B. In group A, 24 patients underwent total cavopulmonary connection (TCPC) 14 +/- 6 months after BDG, and the remaining 5 patients are waiting for TCPC in good condition. In group B, 6 patients underwent TCPC 8 +/- 7 months after BDG. One patient is awaiting TCPC and the remaining patient is considered unsuitable for TCPC. Cardiac catheterization performed in 32 patients showed significant decrease of pulmonary artery (Nakata) index from 307 +/- 73 to 215 +/- 45 mm2/m2 after BDG in group B (p < 0.05). On the other hand, the Nakata index stayed in higher range from 316 +/- 115 to 287 +/- 74 mm2/m2 in group A, and there was a significant correlation between the Nakata index and the percentage of its difference (Y = 40.823 - 0.144 X; n = 26, R = 0.740, p < 0.0001).
  
  
  CONCLUSIONS
  Appropriate additional pulmonary blood flow is useful for the completion of TCPC by means of suppressing the decrease in the size of the pulmonary artery, especially in patients with underdeveloped pulmonary arteries.
authors.affiliation: Department of Cardiothoracic Surgery, Kobe Childre's Hospital, Kobe, Hyogo, Japan. yoshidamasa_kch@hp.pref.hyogo.jp
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamaguchi
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Murakami
authors.forename: Hironori
authors.initials: H
authors.lastname: Matsuhisa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
mesh_terms: D002302:Cardiac Output; D002496:Central Venous Pressure; D002675:Child, Preschool; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D011652:Pulmonary Circulation; D016019:Survival Analysis; D016896:Treatment Outcome; D014655:Vascular Resistance