title: Clinical assessment of diastolic retrograde flow in the descending aorta for high-flow systemic-to-pulmonary artery shunting.
abstract: OBJECTIVE
  To investigate whether echocardiographic characteristics in the descending aorta of patients with cyanotic congenital heart disease who have received a systemic-to-pulmonary artery (SP) shunt can indicate shunt flow volume and predict postoperative adverse events related to high-flow shunting.
  
  
  METHODS
  Among the 73 consecutive patients who received an SP shunt between 2010 and 2014, data for 53 patients who underwent postoperative Doppler echocardiographic assessment of diastolic retrograde flow in the descending aorta (dAo-RF) were reviewed retrospectively.
  
  
  RESULTS
  The mean dAo-RF ratio was 0.50 ± 0.15 at intensive care unit admission and reached its peak level (0.56 ± 0.12) at 24 hours after surgery. All of the patients with a maximal dAo-RF ratio of ≥0.80 had experienced acute heart failure or cardiogenic shock due to postoperative high-flow shunting and required emergent surgical interventions to reduce pulmonary blood flow. Pulse oximetry-measured oxygen saturation and serum lactate level were significantly correlated with dAo-RF ratio, but they had some clinical dispersion to match the postoperative adverse events.
  
  
  CONCLUSIONS
  The dAo-RF ratio is a simple, repeatable, and noninvasive index for postoperative assessment of SP shunt flow volume. A high dAo-RF ratio is a significant predictor of postoperative adverse events of high-flow shunting.
authors.affiliation: Department of Cardiovascular Surgery, Kobe Children's Hospital, Hyogo, Japan. Electronic address: tohasegawa_kch@hp.pref.hyogo.jp.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Department of Cardiovascular Surgery, Kobe Children's Hospital, Hyogo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Oshima
authors.affiliation: Department of Cardiology, Kobe Children's Hospital, Hyogo, Japan.
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Cardiovascular Surgery, Kobe Children's Hospital, Hyogo, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Maruo
authors.affiliation: Department of Cardiovascular Surgery, Kobe Children's Hospital, Hyogo, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Matsuhisa
mesh_terms: D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D058366:Blalock-Taussig Procedure; D001810:Blood Volume / Q000502:physiology*; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology
keywords: diastolic retrograde flow in the descending aorta; high-flow shunting; systemic-to-pulmonary artery shunt