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Pulsatile BCPS

The bidirectional cavopulmonary shunt (BCPS), or bidirectional Glenn shunt, has frequently been
performed as a primary palliation or intermediate step before the ultimate Fontan-type repair in
patients with univentricular heart syndrome.However, several disadvantages regarding nonpulsatile or
decreased pulsatile pulmonary flow after the BCPS have been reported, as well as the importance of
flow pulsatility in both global and microvascular pulmonary circulation. Previous experimental studies
have shown pulmonary vascular resistance to be significantly elevated and lung water content to be
increased with nonpulsatile pulmonary flow. Few reports, however, confirm sequelae caused by
nonpulsatile pulmonary flow in the clinical setting, that is, in patients after BCPS.

The BCPS has become an important staging procedure for the Fontan-type operation in the
management of patients with univentricular heart syndrome. Accessory pulmonary blood in BCPS is still
controversial. Proponents suggest that a dual source of pulmonary blood flow results in more
satisfactory levels of arterial saturation, but opponents emphasize the merits of eliminating volume load
to the heart. Our observations suggest that pulmonary flow pulsatility has crucial effects and support
the utility of BCPS with additional pulmonary flow from the standpoint of pulmonary endothelial
function.

Our data show good flow velocity response to ACH in 2 patients after BCPS with pulmonary pulse
pressure of more than 8 mm Hg and PI of more than 8. This favorable response suggests that pulse
pressure of more than 8 mm Hg for pulsatility is preferable to prevent pulmonary endothelial functional
attenuation under BCPS if the ventricular function is stable.

Kenapa setelah ASO harus diberi aspilet sedangkan ADO tidak??

Traditionally it is recommended to use antiplatelet therapy after ASD and VSD device closures, while not
after PDA closure by duct occluders. There is not a general agreement in the cases of PDA closure by
septal occluders. In contrast to the duct occluder, septal occluders have Dacron polyester patches to
facilitate thrombosis. Spies et al7 administered clopidogrel for one month and aspirin for 6 months after
PDA closure by an Amplatzer septal occluder. In their study, aspirin was discontinued after three months
to expedite disappearance of a refractory residual shunt. Onorato et al9 also administered aspirin to
their patient after PDA closure by an Amplatzer muscular VSD occluder. In the other reports, aspirin was
not used and there was not any report of embolic event. As an atrial septal occluder was used in this
patient with no residual shunt, aspirin was administered for 6 months without any complication.