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Use of the bidirectional cavopulmonary shunt in patients under one year of age

Published online by Cambridge University Press:  19 August 2008

Juan Calderón-Colmenero ,
Samuel Ramírez ,
Maria Rijlaarsdam ,
Alfonso Buendia ,
Carlos Zabal ,
Ernesto Zarco-Martínez  and
Fause Attie
Juan Calderón-Colmenero*
Affiliation:
From the Instituto Nacional de Cardiología “Ignacio Chávez,”, México
Samuel Ramírez
Affiliation:
From the Instituto Nacional de Cardiología “Ignacio Chávez,”, México
Maria Rijlaarsdam
Affiliation:
From the Instituto Nacional de Cardiología “Ignacio Chávez,”, México
Alfonso Buendia
Affiliation:
From the Instituto Nacional de Cardiología “Ignacio Chávez,”, México
Carlos Zabal
Affiliation:
From the Instituto Nacional de Cardiología “Ignacio Chávez,”, México
Ernesto Zarco-Martínez
Affiliation:
From the Instituto Nacional de Cardiología “Ignacio Chávez,”, México
Fause Attie
Affiliation:
From the Instituto Nacional de Cardiología “Ignacio Chávez,”, México
*
Dr. Juan Calderón-Colmenero, Instituto Nacional de Cardiologia “Ignacio Chavez,” Juan Badiano I, Tlalpan, 14080 México, D.F., México.
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Summary

Between January 1990 and March 1992, a bidirectional cavopulmonary shunt was performed in seven patients under one year of age for palliation of complex cyanotic congenital heart disease. Five cases had tricuspid atresia with a restrictive ventricular septal defect. One case presented with complete mirror imagery, right-sided heart, double inlet and double outlet right ventricle with pulmonary stenosis. Another case had isomerism of the left atrial appendages with common atrioventricular valve and double outlet right ventricle. All had a pulmonary arterial index greater than 250 mm/m2 (Nakata index). Age and weights before surgery averaged five months (one to 11 months) and 5.6 kg (range 2.8 to 8.5 kg) respectively. Preoperative mean arterial oxygen saturation measured by cardiac catheterization was 60.05±14% and postoperative mean arterial oxygen saturation on room air was 79.85±6.03% (p<0.05). There were no deaths, although postoperative complications occurred in three patients, namely pleural effusion and pneumothorax. Mean follow-up was 10±4.2 months. The cardiothoracic ratio decreased in all cases. On subsequent echocardiographic studies with pulsed Doppler sampling, low velocity systolic-diastolic forward flow was registered in the pulmonary trunk. The velocity of flow increased clearly during inspiration. The bidirectional cavopulmonary shunt can be considered as primary palliation for complex cardiac malformations with restricted pulmonary flow independent of age and body weight.

Keywords

Bidirectional cavopulmonary shunt
Type
Original Articles
Information
Cardiology in the Young , Volume 5 , Issue 1 , January 1995 , pp. 28 - 30
Copyright
Copyright © Cambridge University Press 1995

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References

Trusler, GA, Williams, WG, Cohen, AJ, Rabinovitch, M, Moes, F, Smallhorn, JF, Coles, JG, Lighfoot, NE, Freedom, RMThe cavopulmonary shunt. Evolution of a concept. Circulation 1990; 82 (Suppl IVyes): IV 131–IV 138.Google ScholarPubMed
Bridges, ND, Jonas, RA, Mayer, JE, Flanagan, MF, Keane, JF, Castañeda, AR.Bidirectional cavopulmonary shunts as interim palliation for high-risk Fontan candidates. Early results. Circulation 1990; 82(suppl IVyes): IV 170–IV 176.Google Scholar
Mazzera, E, Corno, A, Picardo, S, Di Donato, R, Marino, B, Costa, D, Marcelleti, C.Bidirectional cavopulmonary shunts: clinical applications as staged or definitive palliation. Ann Thorac Surg 1989; 47: 415–420.CrossRefGoogle ScholarPubMed
Albanse, SB, Carotti, A, Di Donato, PM, Mazzera, E, Troconis, CJ, Giannico, S, Picardo, S, Marcelleti, C.Bidirectional cavopulmonary anastomosis in patients under two years of age. J Thorac Cardiovasc Surg 1992; 104: 904–909.CrossRefGoogle Scholar
Di Donato, R, Di Carlo, DC, Giannico, S, Marcelletti, C.Palliation of complex cardiac anomalies with subaortic obstruction: New operative approach. J Am Coll Cardiol 1989; 13: 406–412.CrossRefGoogle ScholarPubMed
Bridges, ND, Farrell, PE, Pigott, JD, Norwood, WI, and Chin, AJ.Pulmonary artery index. A non predictor of operative survival in patients undergoing modified Fontan repair. Circulation 1989; 80(Suppl Iyes): I 216– I 221.Google Scholar
Nakata, S, Yasuharu, I, Yoshinori, T, Kurosawa, H, Tenzuka, K, Nakazawa, M, Ando, M, Takao, A.A new method for quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart disease with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 1984; 88:610–619.CrossRefGoogle ScholarPubMed
Glenn, WWL, Patino, JF.Circulatory bypass of the right heart. I. Preliminary observations on the direct delivery of venal cava blood into the pulmonary arterial circulation. Azygos veinpulmonary artery shunt. J Biol Med 1954; 27; 147–151.Google Scholar
Bakulev, AN, Kolesnikov, SA.Anastomosis of superior vena cava and pulmonary artery in the surgical treatment of certain congenital defects of the heart. J Thorac Surg 1959; 37: 693–702.CrossRefGoogle ScholarPubMed
Haller, JA, Adkins, JC, Worthington, M, Ravenhorst, J.Experimental studies on permanent bypass of the right heart. Surgery 1966; 59: 1128–1132.Google ScholarPubMed
Azzolina, G, Eufrate, AS, Pensa, P.Experience in surgical management with a modified cavopulmonary anastomosis. Thorax 1972; 27: 11–15.CrossRefGoogle ScholarPubMed
Hopkins, RA, Armstrong, BE, Serwer, GA, Peterson, RJ, Oldham, N.Physiological rationale for a bidirectional cavopulmonary shunt. J Thorac Cardiovasc Surg 1985; 90: 391–398.CrossRefGoogle ScholarPubMed
Girod, DA, Rice, MJ, Mair, G, Julsand, PR, Puga, FJ, Danielson, GK.Relationship of pulmonary artery size to mortality in patients undergoing the Fontan operations. Circulation 1985; 72(Suppl IIyes): II 93–II 96.Google Scholar
Di Donato, R, di Carlo, P, Squitieri, C.Palliation of cardiac malformations associated with right isomerism (asplenic syndrome) in infancy. Ann Thorac Surg 1987; 44: 35–39.CrossRefGoogle Scholar
Momma, K, Takao, H, Shibata, T.Characteristics and natural history of abnormal atrial rhythms in left isomerism. Am J Cardiol 1990; 65: 231–236.CrossRefGoogle ScholarPubMed