PhD Scientific Days 2022

Clinical Medicine II.

Correlation of pulmonary arterial development and short-term postoperative outcomes in pediatric patients with univentricular heart based on angiography

Text of the abstract

Background and Aim
During the second stage of the three-stage surgical palliation of patients with univentricular hearts the circulation of pulmonary arteries is replaced by a non-pulsating, low-pressure flow, which has a significant effect on the development of pulmonary arteries (PA). The aim of this study is to assess the effect of Glenn surgery on pulmonary arterial development and it’s on short-term postoperative outcomes.

Methods
We examined the parameters obtained from catheter angiography scans of 40 children born between 2008 and 2018, 131 (1-505) days before Glenn surgery and 248 (63-929) days before the total cavopulmonary connection (TCPC) was completed, as well as their relationship with data of postoperative hospitalization.

Results
Z-score (0.8±1.3) of the diameter of the left pulmonary artery (LPA) before Glenn was significantly higher than the Z-score of the right pulmonary artery (RPA) (-0.6±2.0) (p<0.01). Between the two measurements, the LPA Z-score decreased by an average of 2.1±1.0, while the RPA Z-score decreased by 0.6±1.4, thus equalizing the difference in diameter. Glenn anastomosis position was not related to lack of LPA growth. For both PA's, negative correlation was found between the initial Z-score and the percentage increase in diameter (p<0.01). The increase in diameter is only significant in PA with a starting diameter of Z-score<0 (p<0.01). The Nakata index was 280 (101-699) before Glenn and 187 (75-506) before TCPC. Length of stay in postoperative intensive care unit and required circulatory and respiratory support, did not show any correlation with the PA parameters.

Conclusions
According to our data Glenn flow is not able to maintain the disproportionately larger pre-Glenn LPA diameter. However, it cannot be ruled out that the right location of Glenn anastomosis also plays a role in the greater development of RPA. Based on our results, the large diameter difference between the two PA's, poor development of LPA and lower preoperative Nakata indices did not result in worse short-term outcomes. Further examination is needed to determine the cause of the difference in diameter between the two PA's prior to Glenn.