{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:24:50Z","timestamp":1787505890287,"version":"build-2736575974"},"reference-count":35,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Background<\/jats:title>\n The bidirectional cavopulmonary connection (BCPC) is a pivotal stage in the surgical palliation of single-ventricle patients. However, there is ongoing debate regarding the benefits and drawbacks of BCPC with additional or antegrade pulmonary blood flow (AAPBF) in optimizing the subsequent stage\u2014total cavopulmonary connection (TCPC).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the influence of BCPC with AAPBF on pulmonary artery growth and hemodynamic outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A retrospective review was conducted of 167 single-ventricle patients who underwent BCPC at Siriraj Hospital between 2006 and 2022. Patients were categorized into two groups based on AAPBF status: group 1 (with AAPBF,\n n<\/jats:italic>\n \u00a0=\u00a044) and group 2 (without AAPBF,\n n<\/jats:italic>\n \u00a0=\u00a0123). Variables from pre-BCPC and pre-TCPC cardiac catheterization\u2014including pulmonary artery growth, McGoon ratio, Nakata index, mean pulmonary arterial pressure (mPAP), ventricular end-diastolic pressure (EDP), and indexed pulmonary vascular resistance (PVRi)\u2014were compared between groups. Pulmonary artery branch\n z<\/jats:italic>\n -scores were analyzed and adjusted using analysis of covariance (ANCOVA). Survival rate, all-cause mortality, and incidence of atrioventricular valve regurgitation (AVVR) and pulmonary arteriovenous malformation (AVM) were also assessed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Median ages at pre-BCPC assessment were 1.06 years (group 1) and 2.17 years (group 2), and at pre-TCPC assessment were 6.19 and 7.27 years, respectively. Median age at BCPC operation was similar between groups (1.58\n vs.<\/jats:italic>\n 1.51 years). Over a median follow-up of 64.33 months, group 1 showed significantly greater increases in right and left pulmonary artery size compared to group 2 (RPA: 3.27\n vs.<\/jats:italic>\n 1.6 mm (\n p<\/jats:italic>\n \u00a0=\u00a00.019); LPA: 2.38\n vs.<\/jats:italic>\n 0.88 mm (\n p<\/jats:italic>\n \u00a0=\u00a00.004)). The Nakata index increased in group 1 but decreased in group 2 (26.70\n vs.<\/jats:italic>\n \u201384.67 mm\n 2<\/jats:sup>\n \/m\n 2<\/jats:sup>\n ,\n p<\/jats:italic>\n \u00a0<\u00a00.001).\n Z<\/jats:italic>\n -scores confirmed significant growth in both pulmonary arteries when adjusted for body surface area (\n p<\/jats:italic>\n \u00a0<\u00a00.001). No significant differences were found in pre-BCPC mPAP (16\n vs.<\/jats:italic>\n 15 mmHg,\n p<\/jats:italic>\n \u00a0=\u00a00.38), EDP (12\n vs.<\/jats:italic>\n 12 mmHg,\n p<\/jats:italic>\n \u00a0=\u00a00.584), or PVRi (1.77\n vs.<\/jats:italic>\n 2.03 WU m\n 2<\/jats:sup>\n ,\n p<\/jats:italic>\n \u00a0=\u00a00.890). Survival rates did not differ significantly between groups (\n p<\/jats:italic>\n \u00a0=\u00a00.350).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n BCPC with AAPBF effectively promotes pulmonary artery growth without adversely affecting ventricular volume loading or pulmonary artery pressure. Further investigation into the development of arteriovenous malformations is recommended.<\/jats:p>\n <\/jats:sec>","DOI":"10.7717\/peerj.20021","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T08:17:44Z","timestamp":1759738664000},"page":"e20021","source":"Crossref","is-referenced-by-count":1,"title":["Hemodynamic outcomes in patients undergoing bidirectional cavopulmonary connection with additional or antegrade pulmonary blood flow: a single-centre retrospective study"],"prefix":"10.7717","volume":"13","author":[{"given":"Kernfan","family":"Puthikitakawiwong","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chodchanok","family":"Vijarnsorn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teerapong","family":"Tocharoenchok","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakul","family":"Chanthong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kritvikrom","family":"Durongpisitkul","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paweena","family":"Chungsomprasong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 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