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J Thorac Cardiovasc Surg 2005;129:949-950
© 2005 The American Association for Thoracic Surgery

Brief Communications

Early primary Kawashima operation combined with direct hepatic vein-to-azygos vein connection: A new logical approach

^a Division of Pediatric Cardiac Surgery, Bambino Gesù Hospital, Rome, Italy
^b Division of Cardiovascular Bioengineering, Istituto Superiore di Sanità, Rome, Italy
^c Department of Radiology, S. Andrea Hospital, Rome, Italy

Received for publication August 14, 2004; accepted for publication August 19, 2004.

^_* Address for reprints: Antonio Amodeo, MD, Dipartimento Medico Chirurgico di Cardiologia Pediatrica, Ospedale Bambino Gesù, Piazzale S. Onofrio 4, Rome 00165, Italy (E-mail: antonioamodeo@yahoo.it).

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

Dr Amodeo

Patients with single ventricle, left isomerism, and azygos continuation of the inferior vena cava usually undergo a staged cardiac repair comprising a total bidirectional cavopulmonary anastomosis with the exclusion of the hepatic venous return (Kawashima operation) during childhood followed by a complementary hepatic vein-to-pulmonary artery connection (Fontan completion) 2 to 3 years later. The latter step can effectively counteract the progressive cyanosis resulting from both systemic venous collaterals emptying into the low-pressure hepatic venous compartment and pulmonary arteriovenous malformations related to lack of a putative hepatic or splanchnic factor. However, both the intracardiac and the extracardiac conventional pathways for diverting the hepatic venous return to the pulmonary circulation are highly predisposed toward thrombosis.¹ This is caused by an intrinsic tendency for deep vein thromboses typical in patients with . . . [Full Text of this Article]

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