Theoretical optimization of pulmonary-to-systemic flow ratio after a bidirectional cavopulmonary anastomosis

作     者：Santamore, WP Barnea, O Riordan, CJ Ross, MP Austin, EH 

作者机构：Univ Louisville Dept Surg Div Thorac & Cardiovasc Surg Louisville KY 40292 USA Tel Aviv Univ Dept Biomed Engn IL-69978 Tel Aviv Israel Kosair Childrens Hosp Dept Pediat Louisville KY 40292 USA 

出 版 物：《AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY》 (美国生理学杂志：心脏与循环生理学)

年 卷 期：1998年第274卷第2期

页      面：H694-H700页

核心收录：

学科分类：0710[理学-生物学] 1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 10[医学] 

主　　题：hypoplastic left heart syndrome pulmonary blood flow aortic blood flow computer models infants 

摘      要：A univentricle with parallel pulmonary and systemic circulations is inherently inefficient because mixing of pulmonary and systemic venous return occurs. Thus a cavopulmonary anastomosis is used as a staged palliative procedure to reduce volume overload in patients with cyanotic congenital heart disease. On the basis of oxygen uptake and consumption, an equation was derived that related cardiac output, pulmonary venous oxygen saturation, upper body oxygen consumption, and superior-to-inferior vena caval blood flow ratio (Q(SVC)/Q(IVC)) to oxygen delivery. The primary findings were as follows. 1) As Q(SVC)/Q(IVC) increases, total body oxygen delivery and arterial and superior vena caval oxygen saturations increase. 2) As Q(SVC)/Q(IVC) increases, lower body oxygen delivery and inferior vena caval oxygen saturation initially increase, then peals, and then decrease, 3) As the percentage of lower body oxygen consumption increases, oxygen delivery and saturation decrease, 4) A cavopulmonary anastomosis decreases the required cardiac output for a given oxygen delivery. Thus we concluded that a high systemic arterial oxygen saturation after cavopulmonary anastomosis requires a high percentage of upper body oxygen consumption and a high Q(SVC)/Q(IVC) and that the cavopulmonary anastomosis reduces the volume load on the single ventricle.