title: Forward Flow Through the Pulmonary Valve After Bidirectional Cavopulmonary Shunt Benefits Patients at Fontan Operation.
abstract: BACKGROUND
  The impact of additional pulmonary forward flow (APF) through the pulmonary valve at the time of bidirectional cavopulmonary shunt (BCPS) is unknown.
  
  
  METHODS
  Between 2000 and 2010, 276 patients had BCPS and 126 of them were selected, including 60 patients with APF via pulmonary valve and 66 patients, in whom the pulmonary valve was closed. We compared the length of hospital stay and duration of pleural drainage at BCPS and Fontan operations. We also compared the number of surgical interventions before BCPS, the number of operations between BCPS and Fontan operation, Nakata index prior to Fontan operation, grade of atrioventricular valve regurgitation (AVVR), and oxygen saturations prior to Fontan operation.
  
  
  RESULTS
  Prior to BCPS, 20% (12 of 60) of patients with APF and none without APF had pulmonary artery (PA) banding. More patients without APF had systemic-to-PA shunts (p < 0.01). Fontan operation was completed in 58% (35 of 60) of patients with APF and in 68% (45 of 66) of patients without APF (p = 0.34). There was no difference in the length of hospital stay or duration of pleural drainage at BCPS. No significant difference was observed in the number of surgical procedures between BCPS and Fontan operation, grade of AVVR or oxygen saturations before Fontan operation. Children with APF had a higher Nakata index (p = 0.02) prior to Fontan operation, shorter duration of pleural drainage (p = 0.009) and shorter hospital stay (p = 0.009) after Fontan operation.
  
  
  CONCLUSIONS
  Children with APF at BCPS had better developed PAs, shorter duration of pleural drainage, and shorter hospital stay after Fontan operation.
authors: Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia.
authors: Koichi
authors: K
authors: Sughimoto
authors: Murdoch Childrens Research Institute, Melbourne, Australia.
authors: Diana
authors: D
authors: Zannino
authors: Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia.
authors: Jacob
authors: J
authors: Mathew
authors: Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia.
authors: Robert G
authors: RG
authors: Weintraub
authors: Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia.
authors: Christian P
authors: CP
authors: Brizard
authors: Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia.
authors: Yves
authors: Y
authors: d'Udekem
authors: Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia. Electronic address: igor.konstantinov@rch.org.au.
authors: Igor E
authors: IE
authors: Konstantinov
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013997:Time Factors