{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T16:03:24Z","timestamp":1778601804754,"version":"3.51.4"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[1995,11]]},"abstract":"<jats:p>\n            <jats:italic>Background<\/jats:italic>\n            The bidirectional cavopulmonary shunt has become an important intermediate step in the treatment of pediatric patients with single ventricle physiology who are ultimately destined for palliative surgery. We wanted to know whether there would be risks or benefits if an additional source of pulmonary blood flow was left after a bidirectional cavopulmonary shunt.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods and Results<\/jats:italic>\n            We retrospectively reviewed the medical and surgical records of all patients who underwent a bidirectional cavopulmonary shunt at the Children\u2019s Hospital of Wisconsin between January 1991 and December 1993. A total of 43 patients were identified. Anatomic diagnoses included double inlet left ventricle (14 patients), tricuspid atresia (8 patients), pulmonary atresia with intact septum (6 patients), single right ventricle (5 patients), hypoplastic left heart (3 patients), unbalanced atrioventricular septal defect (3 patients), and other complex lesions (4 patients). We then divided the patients into two groups for purposes of analysis. Group 1 had only the cavopulmonary shunt as a source of pulmonary flow (22 patients); group 2 had an additional source of pulmonary flow (21 patients). Patient age at the time of cavopulmonary shunt ranged from 6 months to 12 years, with group 1 patients being younger (31 versus 45 months,\n            <jats:italic>P<\/jats:italic>\n            =.05). Group 2 patients had higher postoperative central venous pressures (17.8 versus 14.1 mm Hg,\n            <jats:italic>P<\/jats:italic>\n            &lt;.001) and oxygen saturations (86% versus 81%,\n            <jats:italic>P<\/jats:italic>\n            &lt;.001) than did group 1 patients. There was no statistical difference between groups in the number of chest tube days or hospital days. There was 1 early death in group 1 related to severe ventricular dysfunction and 1 late death in group 2 related to sepsis. Five patients in group 2 were readmitted to the hospital for drainage of a large chylothorax compared with none in group 1 (\n            <jats:italic>P<\/jats:italic>\n            &lt;.02).\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            We conclude that patients with an additional source of pulmonary blood flow after bidirectional cavopulmonary shunt have higher postoperative central venous pressures, have higher oxygen saturations, and are at risk for the late development of a chylothorax.\n          <\/jats:p>","DOI":"10.1161\/01.cir.92.9.240","type":"journal-article","created":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T00:34:42Z","timestamp":1339461282000},"page":"240-244","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":69,"title":["Does an Additional Source of Pulmonary Blood Flow Alter Outcome After a Bidirectional Cavopulmonary Shunt?"],"prefix":"10.1161","volume":"92","author":[{"given":"Michele A.","family":"Frommelt","sequence":"first","affiliation":[{"name":"From the Division of Pediatric Cardiology, Department of Pediatrics (M.A.F., P.C.F., S.B., A.N.P., D.A.L.) and the Department of Cardiovascular Surgery (J.S.T., S.B.L.), Children\u2019s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter C.","family":"Frommelt","sequence":"additional","affiliation":[{"name":"From the Division of Pediatric Cardiology, Department of Pediatrics (M.A.F., P.C.F., S.B., A.N.P., D.A.L.) and the Department of Cardiovascular Surgery (J.S.T., S.B.L.), Children\u2019s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart","family":"Berger","sequence":"additional","affiliation":[{"name":"From the Division of Pediatric Cardiology, Department of Pediatrics (M.A.F., P.C.F., S.B., A.N.P., D.A.L.) and the Department of Cardiovascular Surgery (J.S.T., S.B.L.), Children\u2019s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew N.","family":"Pelech","sequence":"additional","affiliation":[{"name":"From the Division of Pediatric Cardiology, Department of Pediatrics (M.A.F., P.C.F., S.B., A.N.P., D.A.L.) and the Department of Cardiovascular Surgery (J.S.T., S.B.L.), Children\u2019s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Lewis","sequence":"additional","affiliation":[{"name":"From the Division of Pediatric Cardiology, Department of Pediatrics (M.A.F., P.C.F., S.B., A.N.P., D.A.L.) and the Department of Cardiovascular Surgery (J.S.T., S.B.L.), Children\u2019s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James S.","family":"Tweddell","sequence":"additional","affiliation":[{"name":"From the Division of Pediatric Cardiology, Department of Pediatrics (M.A.F., P.C.F., S.B., A.N.P., D.A.L.) and the Department of Cardiovascular Surgery (J.S.T., S.B.L.), Children\u2019s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. Bert","family":"Litwin","sequence":"additional","affiliation":[{"name":"From the Division of Pediatric Cardiology, Department of Pediatrics (M.A.F., P.C.F., S.B., A.N.P., D.A.L.) and the Department of Cardiovascular Surgery (J.S.T., S.B.L.), Children\u2019s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(89)90384-6"},{"key":"e_1_3_2_2_2","unstructured":"Castaneda AR. From Glenn to Fontan: a continuing evolution. Circulation. 1992;86(suppl II):II-80-II-84."},{"key":"e_1_3_2_3_2","unstructured":"Bridges ND Jonas RA Mayer JE Flanagan MF Keane JF Castaneda AR. Bidirectional cavopulmonary anastomosis as interim palliation for high-risk Fontan candidates. Circulation. 1990;82(suppl IV):IV-170-IV-176."},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)34222-9"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)38595-2"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)35594-1"},{"key":"e_1_3_2_7_2","unstructured":"Kobayashi J Matsuda H Nakano S Shimazaki Y Ikawa S Mitsuno M Takahashi Y Kawashima Y Arisawa J Matsushita T. Hemodynamic effects of bidirectional cavopulmonary shunt with pulsatile pulmonary flow. Circulation. 1991;84(suppl III):III-219-III-225."},{"key":"e_1_3_2_8_2","unstructured":"Trusler GA Williams WG Cohen AJ Rabinovitch M Moes F Smallhorn JF Coles JG Lightfoot NE Freedom RM. The cavopulmonary shunt: evolution of a concept. Circulation. 1990;82(suppl IV):IV-131-IV-138."},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.86.6.1451247"},{"key":"e_1_3_2_10_2","unstructured":"Graham TP Franklin RCG Wyse RKH Gooch V Deanfield JE. Left ventricular wall stress and contractile function in childhood: normal values and comparison of Fontan repair versus palliation only in patients with tricuspid atresia. Circulation. 1986;74(suppl I):I-61-I-69."},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90450-2"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(80)90483-X"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.72.3.4017202"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.55.1.830212"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)42334-9"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(94)70049-4"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)34293-X"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajplegacy.1967.212.6.1469"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/01.CIR.92.9.240","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T15:57:57Z","timestamp":1715529477000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/01.CIR.92.9.240"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1995,11]]},"references-count":18,"journal-issue":{"issue":"9","published-print":{"date-parts":[[1995,11]]}},"alternative-id":["10.1161\/01.CIR.92.9.240"],"URL":"https:\/\/doi.org\/10.1161\/01.cir.92.9.240","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[1995,11]]},"assertion":[{"value":"1995-11-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}