Andersons pediatric cardiology 1830

the venous systems is from the systemic veins to either the pulmonary veins or pulmonary venous atrium Venovenous collateralization in the Fontan circulation is much less common than it is following the bidirectional Glenn procedure In summary, children with a fUVH undergo significant and complex physiologic changes from fetal life through the Fontan procedure, particularly ventricular volume work and pulmonary blood flow The optimal surgical and medical management described in Chapter 71 is best achieved with a thorough understanding of the transitional circulation, the changes in loading conditions, and ventricular output that occur following each stage of surgical management; the variabilities of systemic venous connections and flow following cavopulmonary connections; and thorough anatomic and physiologic evaluation of the surgical reconstructions Annotated References Banka P, McElhinney DB, Bacha EA, et al What is the clinical utility of routine cardiac catheterization before a Fontan operation? Pediatr Cardiol 2010;31:977–985 Although this study was important mainly in describing clinical decision making prior to a Fontan operation, the manuscript also provides invasively measured hemodynamics in a large cohort of children following the superior cavopulmonary connection Barnea O, Austin EH, Richman B, Santamore WP Balancing the circulation: theoretic optimization of pulmonary/systemic flow ratio in hypoplastic left heart syndrome J Am Coll Cardiol 1994;24:1376–1381 One of the first theoretical mathematical models of the multidistribution circulation, suggesting that the “optimal” ratio of systemic-to-pulmonary blood flow” was less than 1.0 This theoretical model required some assumptions from the clinical scenario, particularly oxygen consumption and pulmonary venous saturation Later work has emphasized the contributions of total ventricular output, regurgitant fraction, consumption-delivery mismatch, hemoglobin affinity for oxygen, and other important parameters Nonetheless, this was an important step in the understanding of the multidistribution circulation Bradley SM, Atz AM, Simsic JM, et al Redefining the impact of oxygen and hyperventilation after the Norwood procedure J Thorac Cardiovasc Surg 2004;127:473–480 An important clinical study suggesting that mathematical and/or hypothetical models emphasizing balancing flow and avoiding pulmonary vasodilators to maximize oxygen delivery were limited in their ability to determine optimal oxygen delivery at the bedside Importantly, supplemental oxygen in modest amounts increased oxygen delivery to the tissues Brown DW, Gauvreau K, Powell AJ, et al Cardiac magnetic resonance versus routine cardiac catheterization before bidirectional Glenn anastomosis: long-term follow-up of a prospective randomized trial J Thorac Cardiovasc Surg 2013;146:1172–1178 As with the study by Banks and colleagues already mentioned, this paper provides invasively measured hemodynamics in a large cohort of