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J Thorac Cardiovasc Surg 2005;129:451-452
© 2005 The American Association for Thoracic Surgery

Brief Communications

Modified fenestration technique for the Kawashima operation in a young infant

^a Division of Cardiac Surgery, Congenital Cardiac and Transplantation Unit, American Cardiac Center, American Hospital, Montevideo, Uruguay
^b Department of Cardiology, Congenital Cardiac and Transplantation Unit, American Cardiac Center, American Hospital, Montevideo, Uruguay
^c Intensive Care Unit, Congenital Cardiac and Transplantation Unit, American Cardiac Center, American Hospital, Montevideo, Uruguay

Received for publication June 7, 2004; accepted for publication June 10, 2004.

^* Address for reprints: Dante Picarelli, MD, Unidad de Cardiopatías Congénitas y Trasplante, Centro Cardiológico Americano, Sanatorio Americano–Isabelino Bosch 2469, Montevideo 11600 Uruguay (E-mail: picarelli54@hotmail.com).

The first 20% of the full text of this article appears below.

Dr Picarelli

Cases involving small infants undergoing the Kawashima operation for left atrial isomerism, single ventricle, and azygos continuation of the inferior vena cava are rare and challenging because of the risk associated with this particular circulation, which is similar to a total cavopulmonary shunt, except for the hepatic flow.¹

Taking into account the recent encouraging report from Hannan and associates,² we decided to perform a modified fenestrated Kawashima operation, preserving a limited antegrade flow, in a 5-month-old infant with severe cyanosis caused by progressive pulmonary stenosis.

	Clinical summary

 
With a previous prenatal echocardiographic diagnosis of single double-outlet right ventricle, malposition of the great arteries, common atrium and atrioventricular valve, and azygos continuation of interrupted inferior vena cava, a female neonate was born after 37 weeks' gestation weighing 2760 g. She had mild cyanosis (oxygen saturation of 85%) without signs of cardiac failure. Postnatal echocardiography confirmed the diagnosis and revealed a mild subpulmonary stenosis (23 mm Hg gradient) and bilateral superior venae cavae.

After 5 months, cyanosis progressively increased (oxygen . . . [Full Text of this Article]

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