Circulation, Vol 72, 471-479, Copyright © 1985 by American Heart Association
A Cloutier, JM Ash, JF Smallhorn, WG Williams, GA Trusler, RD Rowe and M Rabinovitch
Since the Fontan procedure results in low pulsatile pulmonary blood flow
similar to that seen in patients with a Glenn shunt, it may also be
associated with abnormal distribution of flow to the lower lung lobes and
with the development of pulmonary arteriovenous fistulae (PAVF). In 12
patients 0.8 to 4.5 years after Fontan procedure and in 20 patients 0.2 to
18 years after receipt of Glenn shunts we assessed ventilation (with 133Xe)
and perfusion (after a peripheral injection of 99mTc-macroaggregated
albumin) to compare upper to lower lobe distribution of blood flow with
that in a control group. The presence of PAVF was assessed by radionuclide
activity in kidneys and the brain and by a two-dimensional
echocardiographic contrast study. A decreased upper/lower lobe perfusion
ratio was noted in 13 of 20 patients with Glenn shunts (65%) and correlated
with the time after surgery (p less than .05). Despite the shorter
follow-up period, two of 12 (16%) patients who had undergone the Fontan
procedure also had a decreased upper/lower lobe perfusion ratio, and one of
these developed right heart failure. Brain and kidney radionuclide counts
above control values were observed in all patients with Glenn shunts and in
11 of 12 patients who had the Fontan operation. However, in only five of 20
(25%) patients with Glenn shunts were PAVF confirmed by the two-
dimensional echocardiographic contrast study. Three of the five patients
with PAVF had Glenn shunts of long duration.(ABSTRACT TRUNCATED AT 250
WORDS)
ARTICLES
Abnormal distribution of pulmonary blood flow after the Glenn shunt or Fontan procedure: risk of development of arteriovenous fistulae
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