Evaluations Before Partial and Total Cavopulmonary Connections

Abstract

Patients with single ventricle physiology have a variety of complex heart diseases that are not suitable to biventricular repair. Partial cavopulmonary connection, with or without additional pulmonary blood flow, usually precedes conversion to total cavopulmonary connection, which allows the passive flow of the systemic venous blood into the lungs. Partial and total cavopulmonary connection are often preceded by cardiac catheterisation, aimed at measuring pulmonary arterial pressure, assessing pulmonary artery size and treating possible associated anomalies. Commonly associated anomalies that may be treated percutaneously are aortic recoarctation, aortopulmonary collaterals, venovenous collaterals, pulmonary fistulae, restrictive foramen ovale, stenosis or disconnection of pulmonary arteries and stenosis of the superior vena cava. Catheterisation is performed in either all or selected patients, according to the team policy and depending on the availability of high-quality noninvasive imaging. The ideal pre-Glenn patient has low pulmonary arterial pressure and normal pulmonary artery size. He has non-obstructed pulmonary venous return, non-restrictive atrial septal defect, normal ventricular function and non-obstructed ventricular outflow and does not have aortopulmonary collaterals. The ideal pre-Fontan patient has mean pulmonary arterial pressure <14–16 mmHg, normal pulmonary artery size, normal ventricular function and competent atrioventricular valve(s). He has no venovenous collaterals or pulmonary fistulae, non-obstructed pulmonary venous return, non-restrictive atrial septal defect and non-obstructed ventricular outflow and does not have aortopulmonary collaterals.