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The Journal of Thoracic and Cardiovascular Surgery, Vol 87, 74-81, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Y Kawashima, S Kitamura, H Matsuda, Y Shimazaki, S Nakano and H Hirose
Four patients with presently uncorrectable cyanotic cardiac anomalies
underwent a new operation, "total cavopulmonary shunt operation" or "total
right heart bypass operation." These anomalies included single ventricle,
single atrium, common atrioventricular valve with or without regurgitation,
pulmonary stenosis, and most important, absent inferior vena cava with
azygos or hemiazygos continuation. All patients had had previous
systemic-pulmonary shunts. The new operation consisted of end- to-side
anastomosis between the superior vena cava with azygos or hemiazygos
continuation and the confluent pulmonary artery, division or ligation of
the pulmonary artery trunk, and replacement of the common atrioventricular
valve when regurgitation was present. Thus total venous return, except for
hepatocardiac venous and coronary sinus flow, drains directly into the
pulmonary artery, bypassing the right atrium and ventricle. Three patients
survived the operation, and two of the three patients are now alive 4
years, 8 months and 2 years, 6 months after the operation. The two
long-term survivors are in significantly improved condition, both
clinically and hemodynamically. We believe that this new operation is
promising in the treatment of the otherwise uncorrectable complex cardiac
anomalies associated with azygos or hemiazygos continuation of the inferior
vena cava. A longer follow-up is certainly mandatory before final
conclusions can be reached.
ARTICLES
Total cavopulmonary shunt operation in complex cardiac anomalies. A new operation
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