985-54 Do Central Pulmonary Arteries Grow Following Bidirectional Superior Cavopulmonary Anastomosis?

Abstract

Listen

Translate article

The role of bidirectional superior cavopulmonary anastomosis (BCPA) in palliation of complex congenital heart defects is now established but little is known about the growth of pulmonary arteries following this operation. Between 1987 and 1993, 74 children underwent BCPA in 2 centres. Of these 21 were further studied by postoperative angiography and are the subject of this investigation. Their median age at BCPA was 23 months (range 1–108 months). BCPA was undertaken through a thoracotomy in 5 and through a midline sternotomy on cardiopulmonary bypass in 16. Competitive sources of pulmonary blood flow were left open in 9 patients. Follow-up angiograms were performed 1–65 months (median 11 months) postoperatively. Z-scores, which standardize pulmonary arteries to body surface area, were calculated from measurement of the diameter immediately prior to the first branching point of each pulmonary artery. The pre- and postoperative bodysurface areas increased from 0.46 m2 (SD 0.21) to 0.66 m2 (SD 0.22). The pre- and postoperative Z-scores of the right pulmonary artery were –1.77 (SO 2.63) and –0.38 (SD 1.69) respectively. The left pulmonary artery Z-scores were -0.08 (SD 2.14) and –0.17 (SD 1.31) pre- and post- operatively. In the subset of 13 patients with reduced pulmonary blood flow (O2 saturation < 0.75) preoperatively, the right pulmonary artery grew in excess of somatic growth (mean Z-score –2.63 pre and –0.62 postoperatively; p = 0.003). There was no difference in growth of the pulmonary arteries in patients with and without competitive pulmonary blood flow. Our preliminary results demonstrate that adequate growth of the pulmonary arteries occurs following BCPA in short term follow-up.