Andersons pediatric cardiology 1830

thevenoussystemsisfromthesystemicveinstoeitherthepulmonaryveinsor
pulmonaryvenousatrium.VenovenouscollateralizationintheFontancirculation
ismuchlesscommonthanitisfollowingthebidirectionalGlennprocedure.
Insummary,childrenwithafUVHundergosignificantandcomplex
physiologicchangesfromfetallifethroughtheFontanprocedure,particularly
ventricularvolumeworkandpulmonarybloodflow.Theoptimalsurgicaland
medicalmanagementdescribedinChapter71isbestachievedwithathorough
understandingofthetransitionalcirculation,thechangesinloadingconditions,
andventricularoutputthatoccurfollowingeachstageofsurgicalmanagement;
thevariabilitiesofsystemicvenousconnectionsandflowfollowing
cavopulmonaryconnections;andthoroughanatomicandphysiologicevaluation
ofthesurgicalreconstructions.


AnnotatedReferences
BankaP,McElhinneyDB,BachaEA,etal.Whatis
theclinicalutilityofroutinecardiac
catheterizationbeforeaFontanoperation?
PediatrCardiol.2010;31:977–985.
Althoughthisstudywasimportantmainlyin
describingclinicaldecisionmakingpriortoa
Fontanoperation,themanuscriptalsoprovides
invasivelymeasuredhemodynamicsinalarge
cohortofchildrenfollowingthesuperior
cavopulmonaryconnection..
BarneaO,AustinEH,RichmanB,SantamoreWP.
Balancingthecirculation:theoreticoptimization
ofpulmonary/systemicflowratioinhypoplastic
leftheartsyndrome.JAmCollCardiol.
1994;24:1376–1381.
Oneofthefirsttheoreticalmathematicalmodelsof

themultidistributioncirculation,suggestingthat
the“optimal”ratioofsystemic-to-pulmonary
bloodflow”waslessthan1.0.Thistheoretical
modelrequiredsomeassumptionsfromthe
clinicalscenario,particularlyoxygen
consumptionandpulmonaryvenoussaturation.
Laterworkhasemphasizedthecontributionsof
totalventricularoutput,regurgitantfraction,


consumption-deliverymismatch,hemoglobin
affinityforoxygen,andotherimportant
parameters.Nonetheless,thiswasanimportant
stepintheunderstandingofthemultidistribution
circulation..
BradleySM,AtzAM,SimsicJM,etal.Redefining
theimpactofoxygenandhyperventilationafter
theNorwoodprocedure.JThoracCardiovasc
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Animportantclinicalstudysuggestingthat
mathematicaland/orhypotheticalmodels
emphasizingbalancingflowandavoiding
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deliverywerelimitedintheirabilitytodetermine
optimaloxygendeliveryatthebedside.
Importantly,supplementaloxygeninmodest
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BrownDW,GauvreauK,PowellAJ,etal.Cardiac
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catheterizationbeforebidirectionalGlenn
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AswiththestudybyBanksandcolleaguesalready
mentioned,thispaperprovidesinvasively
measuredhemodynamicsinalargecohortof