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Bidirectional cavopulmonary shunt with an additional source of pulmonary flow: an interim or final stage of palliation

Published online by Cambridge University Press:  19 August 2008

Ronald W. Day ,
Charles M. Baker ,
John R. Caton ,
John A. Hawkins  and
Edwin C. McGough
Ronald W. Day*
Affiliation:
Divisions of Pediatric Cardiology and Cardiothoracic SurgeryUniversity of Utah and Primary Children's Medical Center, 100 North Medical Drive, Salt Lake City, Utah, USA
Charles M. Baker
Affiliation:
Divisions of Pediatric Cardiology and Cardiothoracic SurgeryUniversity of Utah and Primary Children's Medical Center, 100 North Medical Drive, Salt Lake City, Utah, USA
John R. Caton
Affiliation:
Divisions of Pediatric Cardiology and Cardiothoracic SurgeryUniversity of Utah and Primary Children's Medical Center, 100 North Medical Drive, Salt Lake City, Utah, USA
John A. Hawkins
Affiliation:
Divisions of Pediatric Cardiology and Cardiothoracic SurgeryUniversity of Utah and Primary Children's Medical Center, 100 North Medical Drive, Salt Lake City, Utah, USA
Edwin C. McGough
Affiliation:
Divisions of Pediatric Cardiology and Cardiothoracic SurgeryUniversity of Utah and Primary Children's Medical Center, 100 North Medical Drive, Salt Lake City, Utah, USA
*
Ronald W. Day Division of Pediacric Cardiology, University of Utah, 100 North Medical Drive, Salt Lake City, UT 84113 Tel:(801) 588 2600, Fax:(801)588 2612.
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Abstract

A bidirectional cavopulmonary shunt is performed in patients with single ventricle physiology to improve or maintain systemic oxygenation while decreasing the workload of the heart. During a period of 10 years, bidirectional cavopulmonary shunts were performed in 50 patients at our institution. The procedure was performed with an additional source of pulmonary flow through the pulmonary valve or a systemic to pulmonary shunt in 27 patients and without an additional source of pulmonary flow in 23 patients. Preoperative and postoperative chest radiographs, pulmonary angiograms, oxygenation, hemodynamic measurements, morbidity, and mortality were reviewed to determine whether a bidirectional cavopulmonary shunt with an additional source of pulmonary flow is an acceptable interim or final stage of palliation. Systemic oxygenation was improved only in patients with an additional source of pulmonary flow. The outcome of the bidirectional cavopulmonary shunt was not adversely affected by the presence of additional pulmonary flow. Twenty-five patients subsequently underwent an atrial to pulmonary or total cavopulmonary anastomosis. Oxygenation was improved by more definitive palliation; however, late complications of stroke, protein losing enteropathy, and arrhythmias requiring pacemaker therapy were more prevalent. In conclusion, systemic oxygenation can be improved by performing the bidirectional cavopulmonary shunt with an additional source of pulmonary flow through the pulmonary valve or a systemic to pulmonary shunt without an adverse effect on hemodynamic measurements, pulmonary arterial growth, morbidity, or survival. The bidirectional avopulmonary shunt may be an acceptable final stage of palliation in some patients with a functionally single ventricle.

Keywords

Bidirectional cavopulmonary shunttotal cavopulmonary anastomosiscyanosiscongential heart disease
Type
Original Articles
Information
Cardiology in the Young , Volume 7 , Issue 1 , January 1997 , pp. 63 - 70
Copyright
Copyright © Cambridge University Press 1997

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References

1.Glenn, WWL. Circulatory bypass of the right side of the heart. IV. Shunt between superior vena cava and the right pulmonary artery-report of clinical applications. New Engl J Med 1958;259:117–120.CrossRefGoogle Scholar
2.Abrams, LD. Side-to-side cavo-pulmonary anastomosis for palliation of “primative ventricle”. Br Heart J 1977; 39:926 (abstract).Google Scholar
3.Azzolina, G, Eufrate, S, Pensa, P. Tricuspid atresia. Experience in surgical manabement with a modified cavopulmonary anastomosis. Thorax 1972; 27:111–115.CrossRefGoogle ScholarPubMed
4.Kobayashi, J, Matsuda, H, Nakano, S, Shimazaki, Y, Ikawa, S, Mitsuno, M, Takahashi, Y, Kawashima, Y, Arisawa, J, Matsushita, T. Hemodynamic effects of bidirectional cavopulmonary shunt with pulsatile pulmonary flow. Circulation 1991;84:III-219–III-225.Google ScholarPubMed
5.Hawkins, JA, Shaddy, RE, Day, RW, Sturtevant, JE, Orsmond, GS, McGough, EC. Mid-term results after bidirectional cavopulmonary shunts. Ann Thorac Surg 1993; 56:833–837.CrossRefGoogle ScholarPubMed
6.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 diseases with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 1984;88:610–619.CrossRefGoogle ScholarPubMed
7.Mendelsohn, AM, Bove, EL, Lupinetti, FM, Crowley, DC, Lloyd, TR, Beekman, RH. Central pulmonary artery growth patterns after the bidirectional Glenn procedure. J Thorac Cardiovasc Surg 1994; 107:1284–1290.CrossRefGoogle ScholarPubMed
8.Penny, DJ, Pawade, A, Wilkinson, JL, Karl, TR. Pulmonary artery size after bidirectional cavopulmonary connection. J Cardiac Surg 1995;10:21–26.CrossRefGoogle ScholarPubMed
9.Uemura, H, Yagihara, T, Kawashima, Y, Okada, K, Kamiya, T, Anderson, RH. Use of the bidirectional Glenn procedure in the presence of forward flow from the ventricles to the pulmonary arteries. Circulation 1995;92:II-228–II-232.CrossRefGoogle Scholar
10.Uemura, H, Yagihara, T, Yamamoto, F, Nishigaki, K, Matsuki, O, Kawashima, Y. Forward flow from ventricle suppresses development of collateral circulation after cavopulmonary shunt. J Am Coll Cardiol 1993;21:82A (abstract).Google Scholar
11.Day, RW, Orsmond, GS, Sturtevant, JE, Hawkins, JA, Doty, DB, McGough, EC. Early and intermediate results of the Fontan procedure at moderately high altitude. Ann Thorac Surg 1994;57:170–176CrossRefGoogle ScholarPubMed
12.Webber, SA, Horvath, P, LeBlanc, JG, Slavik, Z, Lamb, RK, Monro, JL, Reich, O, Hruda, J, Sandor, GGS, Keeton, BR, Salmon, AP. Influence of competitive pulmonary blood flow on the bidirectional superior cavopulmonary shunt: a multiinstitutional study. Circulation 1995;92:II-279–II-286.CrossRefGoogle Scholar
13.Frommelt, MA, Frommelt, PC, Berger, S, Pelech, AN, Lewis, DA, Tweddell, JS, Litwin, SB. Does an additional source of pulmonary blood flow alter outcome after a bidirectional cavopulmonary shunt? Circulation 1995;92:II-240–II-244.CrossRefGoogle ScholarPubMed
14.Mainwaring, RD, Lamberti, JJ, Uzark, K, Spicer, RL. Bidirectional Glenn: Is accessory pulmonary blood flow good or bad? Circulation 1995;92:II-294–II-297.CrossRefGoogle ScholarPubMed
15.Srivastava, D, Preminger, T, Lock, JE, Mandell, V, Keane, JF, Mayer, JE, Kozakewich, H, Spevak, PJ. Hepatic venous blood and the development of pulmonary arteriovenous malformations in congenital heart disease. Circulation 1995;92: 1217–1222.CrossRefGoogle ScholarPubMed
16.Zellers, TM, Driscoll, DJ, Mottram, CD, Puga, FJ, Schaff, HV, Danielson, GK. Exercise tolerance and cardiopulmonary response to exercise before and after the Fontan operation. Mayo Clin Proc 1989;64:1489‘1497.CrossRefGoogle Scholar
17.Salmon, AP, Sethia, B, Silove, D, Goh, D, Mitchell, I, Alton, H, de Giovanni, JV, Wright, JGC, Abrams, LD. Cavopulmonary anastomosis as long-term palliation for patients with tricuspid atresia. Eur J Cardiothorac Surg 1989;3:494–498.CrossRefGoogle ScholarPubMed