COMPARISON OF PATTERNS OF PULMONARY VENOUS-BLOOD FLOW IN THE FUNCTIONAL SINGLE VENTRICLE HEART AFTER OPERATIVE AORTOPULMONARY SHUNT VERSUS SUPERIOR CAVOPULMONARY SHUNT

In this study we investigated the patterns of pulmonary venous Flow in children with functional single ventricles to obtain a better underst anding of the determinants of transpulmonary blood flow. Sixty-eight p atients with functional single ventricles and aortopulmonary shunt (n = 34, group I), or superior cavopulmonary connection (n = 34, group II ) underwent transesophageal Doppler echocardiographic assessment of fl ow in the left upper pulmonary vein before undergoing the next stage o f surgery. Twelve patients from group ii also underwent simultaneous e valuation of superior vena caval flow. Biphasic forward pulmonary veno us flow was noted in 62 patients in sinus rhythm (S wave in systole, D wave in diastole); in 6 patients with junctional rhythm, significant early systolic reversal of flow was present. Both the Sand D-wave velo city-time integrals (VTI) were greater ingroup I than in group II (S-V TI 9.9 +/- 4.2 vs 8.0 +/- 2.6, p = 0.02; D-VTI 8.0 +/- 3.5 vs 4.2 +/- 2.6, p < 0.001). in both groups, pulmonary venous flow was predominant ly systolic; however, the proportion of flow during ventricular systol e was significantly greater in group II than in group I (S-VTI/D-VTI g roup II: 2.4 +/- 1.5; group I 1.4 +/- 0.5, p = 0.001; percent systolic fraction of pulmonary venous flow group ii = 67%, group I = 56%, p < 0.001), Analysis of superior vena caval flow in group II revealed a si ngle predominant wave with onset at early systole and peak in late sys tole at a mean of 150 ms after the pulmonary venous S-wave peak. Our d ata suggest that ventricular systole (i.e., atrial relaxation, atriove ntricular valve descent) asserts great influence on transpulmonary blo od flow in the functional single ventricle. (C) 1997 by Excerpta Medic o, Inc.