- 作者：Rol ; Henaine ; Mathieu Vergnat ; Olaf Mercier ; Alain Serraf ; Vincent De Montpreville ; Jean Ninet ; Emile A. Bacha
- 关键词：CPS ; cavopulmonary shunt ; Fio2 ; inspired oxygen fraction ; PA ; pulmonary artery ; PAP ; pulmonary artery pressure ; Pco2 ; partial pressure of carbon dioxide ; Po2 ; partial pressure of oxygen ; PVP ; pulmonary vein pressure ; PVR ; pulmonary vascular resistance ; Sao2 ; arterial oxyhemoglobin saturation ; SVC ; superior vena cava
- 刊名：The Journal of Thoracic and Cardiovascular Surgery
- 出版年：December, 2013
- 年：2013
- 卷：146
- 期：6
- 页码：1359-1365
- 全文大小：841 K
Objectives
Continuous flow in Fontan circulation results in impairment of pulmonary artery endothelial function, increased pulmonary vascular resistance, and, potentially, late failure of Fontan circulation. Bidirectional cavopulmonary shunt is the interim procedure in palliation of patients with single-ventricle physiology, but pulmonary arteriovenous malformations occur in many patients. In a porcine chronic model of cavopulmonary shunt, we studied pulmonary hemodynamics, pulmonary arteriovenous malformation occurrence, and gas exchange capabilities. We hypothesized that residual antegrade pulsatile pulmonary flow may attenuate the deleterious effects of nonpulsatile Fontan-type circulation.Methods
Thirty pigs underwent a sham procedure (n聽=聽10, group I), a cavopulmonary shunt with right pulmonary artery ligation (n聽=聽10, group II, nonpulsatile), or a cavopulmonary shunt with proximal right pulmonary artery partial ligation (n聽=聽10, group III, micropulsatile). Three months later, in聽vivo hemodynamics, blood gas exchange, pulmonary arteriovenous malformation occurrence, and lung histology were assessed.
Results
At 3 months, group II right lungs demonstrated significantly increased pulmonary artery pressure, pulmonary vascular resistance, and evidence of pulmonary arteriovenous malformations compared with groups I and III (all P聽<聽.001). Group III lungs also showed increased pulmonary artery pressure and pulmonary vascular resistance compared with the sham group, but significantly less than group II. Group III right lungs had the best gas exchange performance, with less histologic changes compared with group II.
Conclusions
We developed a viable chronic large animal model of bidirectional cavopulmonary anastomosis. Residual antegrade pulsatile flow in the setting of a cavopulmonary shunt prevents pulmonary arteriovenous malformation formation and attenuates, but does not suppress, the development of pulmonary hypertension. From a clinical standpoint, these data would support keeping a small amount of antegrade pulsatile flow during creation of a cavopulmonary shunt.