Theoretical optimization of pulmonary-to-systemic flow ratio after a bidirectional cavopulmonary anastomosis. 1998

W P Santamore, and O Barnea, and C J Riordan, and M P Ross, and E H Austin
Department of Surgery, University of Louisville, Kentucky 40292, USA.

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 (QSVC/QIVC) to oxygen delivery. The primary findings were as follows. 1) As QSVC/QIVC increases, total body oxygen delivery and arterial and superior vena caval oxygen saturations increase. 2) As QSVC/QIVC increases, lower body oxygen delivery and inferior vena caval oxygen saturation initially increase, then peak, 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 QSVC/QIVC and that the cavopulmonary anastomosis reduces the volume load on the single ventricle.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D008954 Models, Biological Theoretical representations that simulate the behavior or activity of biological processes or diseases. For disease models in living animals, DISEASE MODELS, ANIMAL is available. Biological models include the use of mathematical equations, computers, and other electronic equipment. Biological Model,Biological Models,Model, Biological,Models, Biologic,Biologic Model,Biologic Models,Model, Biologic
D010100 Oxygen An element with atomic symbol O, atomic number 8, and atomic weight [15.99903; 15.99977]. It is the most abundant element on earth and essential for respiration. Dioxygen,Oxygen-16,Oxygen 16
D010101 Oxygen Consumption The rate at which oxygen is used by a tissue; microliters of oxygen STPD used per milligram of tissue per hour; the rate at which oxygen enters the blood from alveolar gas, equal in the steady state to the consumption of oxygen by tissue metabolism throughout the body. (Stedman, 25th ed, p346) Consumption, Oxygen,Consumptions, Oxygen,Oxygen Consumptions
D011652 Pulmonary Circulation The circulation of the BLOOD through the LUNGS. Pulmonary Blood Flow,Respiratory Circulation,Circulation, Pulmonary,Circulation, Respiratory,Blood Flow, Pulmonary,Flow, Pulmonary Blood,Pulmonary Blood Flows
D011667 Pulmonary Veins The veins that return the oxygenated blood from the lungs to the left atrium of the heart. Pulmonary Vein,Vein, Pulmonary,Veins, Pulmonary
D002302 Cardiac Output The volume of BLOOD passing through the HEART per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with STROKE VOLUME (volume per beat). Cardiac Outputs,Output, Cardiac,Outputs, Cardiac
D006330 Heart Defects, Congenital Developmental abnormalities involving structures of the heart. These defects are present at birth but may be discovered later in life. Congenital Heart Disease,Heart Abnormalities,Abnormality, Heart,Congenital Heart Defect,Congenital Heart Defects,Defects, Congenital Heart,Heart Defect, Congenital,Heart, Malformation Of,Congenital Heart Diseases,Defect, Congenital Heart,Disease, Congenital Heart,Heart Abnormality,Heart Disease, Congenital,Malformation Of Heart,Malformation Of Hearts
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014682 Vena Cava, Inferior The venous trunk which receives blood from the lower extremities and from the pelvic and abdominal organs. Inferior Vena Cava,Inferior Vena Cavas,Vena Cavas, Inferior

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