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The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 22-29, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JJ Lamberti, RL Spicer, JD Waldman, TM Grehl, D Thomson, L George, SE Kirkpatrick and JW Mathewson
The bidirectional cavopulmonary shunt improves systemic arterial oxygen
saturation without increasing ventricular work or pulmonary vascular
resistance. Since 1983, 17 patients have undergone a cavopulmonary shunt
procedure (five primary operations, 12 secondary operations). Diagnoses
were single ventricle complex (n = 4), hypoplastic right heart syndrome (n
= 10), and hypoplastic left ventricle (n = 3). Age at primary operation
ranged from 3 1/2 to 30 months (median 6 months). Weight ranged from 3.5 to
9.7 kg. Age at secondary operation ranged from 10 months to 14 years
(median 15 months). Seven cavopulmonary shunt operations were performed
without cardiopulmonary bypass (six via thoracotomy and one via sternotomy)
and 10, with cardiopulmonary bypass. All patients in the bypass group had
additional procedures: takedown of modified Blalock-Taussig shunt, seven
patients; revision of right ventricular outflow tract, four patients;
reconstruction of pulmonary arteries, four patients; tricuspid
valvuloplasty, one patient; and Damus procedure, one patient. There was one
(1/17) operative death (Damus procedure). One patient required early
revision. Follow-up ranges from 1 to 53 months (median 23 months). Twelve
of 16 had a good to excellent late result, with a rise in mean arterial
oxygen saturation from 69% to 83%. Three patients died late (4 to 53
months) (pulmonary vascular disease, pulmonary arteriovenous malformations,
and pneumonia, one patient each). There was one late failure (converted to
Glenn shunt). The cavopulmonary shunt is an excellent palliative procedure
when right atrium-pulmonary artery connection (modified Fontan) must be
deferred because of age, weight, or anatomic considerations. Five patients
have undergone right atrium- pulmonary artery connection later. In
addition, at the time of the modified Fontan operation, the cavopulmonary
shunt approach may optimize the anatomic connection (eight additional
patients).
ARTICLES
The bidirectional cavopulmonary shunt
Division of Cardiology, Children's Hospital and Health Center, San Diego, Calif.
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