title: Persistent antegrade pulmonary blood flow post-glenn does not alter early post-Fontan outcomes in single-ventricle patients.
abstract: BACKGROUND
  The bidirectional Glenn cavopulmonary anastomosis (BDG) represents the standard interim procedure in treatment of patients with single-ventricle physiology. Anterograde pulmonary blood flow (APBF) maintained after BDG has been shown both to improve and to complicate postoperative clinical course. We studied its effects on outcome after BDG and eventual Fontan completion.
  
  
  METHODS
  From November 1995 to November 2005, 60 patients underwent BDG and Fontan. All patients had APBF from the ventricle to the pulmonary artery at time of BDG. In group 1 (n = 39) APBF was maintained after BDG, whereas APBF was interrupted at BDG in group 2 (n = 21). Cardiac catheterization data, interstage morbidity, and postoperative outcome variables were recorded.
  
  
  RESULTS
  Pre-BDG hemodynamics differed only in that the mean pulmonary artery pressure was higher in group 2 (17.0 +/- 4.4 mm Hg) than in group 1 (13.8 +/- 4.5 mm Hg; p = 0.03). There were no differences between groups 1 and 2 in BDG outcome variables. At pre-Fontan catheterization, group 1 had higher mean pulmonary artery pressure (13.3 versus 10.9 mm Hg, p = 0.01), arterial oxygen saturation (85.8 versus 80.9%, p = 0.0001), and fewer collateral vessels were coil embolized than in group 2 (0.9 versus 1.6, p = 0.02). Mean ventricular end-diastolic pressure was similar between groups. The Nakata index in group 1 remained stable from pre-BDG to pre-Fontan (348 versus 391, p = 0.24), but it decreased in group 2 (375 versus 227, p = 0.046).
  
  
  CONCLUSIONS
  Patients with anterograde pulmonary blood flow after BDG had a modest increase in pulmonary artery growth and arterial oxygen saturations, and decreased collateral vessel formation. This did not, however, confer additional benefit on outcome after BDG or on eventual Fontan completion.
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Gray
authors.forename: Karen
authors.initials: K
authors.lastname: Altmann
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Mosca
authors.forename: Ashwin
authors.initials: A
authors.lastname: Prakash
authors.forename: Ismee A
authors.initials: IA
authors.lastname: Williams
authors.forename: Jan M
authors.initials: JM
authors.lastname: Quaegebeur
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Chen
mesh_terms: D006328:Cardiac Catheterization; D002675:Child, Preschool; D004452:Echocardiography; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011652:Pulmonary Circulation; D012189:Retrospective Studies