Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-24T16:04:11.719Z Has data issue: false hasContentIssue false
  • English
  • Français

New approach in partial cavopulmonary connection

Published online by Cambridge University Press:  19 August 2008

Paulo. P. Paulista ,
Maria Virginia. T. Santana ,
Antonio. T. M. Henriques Neto  and
Valmir F. Fontes
Paulo. P. Paulista*
Affiliation:
Departments of Cardiovasular Surgery and Pediatric Cardiology, ‘Dante pazzanese’ Institue of Cardiology, Sã paulo, Brazil
Maria Virginia. T. Santana
Affiliation:
Departments of Cardiovasular Surgery and Pediatric Cardiology, ‘Dante pazzanese’ Institue of Cardiology, Sã paulo, Brazil
Antonio. T. M. Henriques Neto
Affiliation:
Departments of Cardiovasular Surgery and Pediatric Cardiology, ‘Dante pazzanese’ Institue of Cardiology, Sã paulo, Brazil
Valmir F. Fontes
Affiliation:
Departments of Cardiovasular Surgery and Pediatric Cardiology, ‘Dante pazzanese’ Institue of Cardiology, Sã paulo, Brazil
*
Dr Paulo P Paulista, ‘Dante Pazzanese’ Institute of Cardiology, Av. Dante Pazzanese 500 – Ibirapuera, 04012-180 São Paulo – SP, Brazil. Tel: 55 11 549 1144ext 134; Fax: 55 11 571 5621
Get access Rights & Permissions [Opens in a new window]

Abstract

The development of pulmonary atteriovenous fistulas after bidirectional cavopuomonary operat-tions, such as the bidirectional Glenn shunt and Kawashima's procedure, has raised concern. Development of these fistulas, which are more frequent than initially thought, can represnt a limiting factor in the late outcome of these patients and may even limit the indication for these of surgery. Whether the fistulas can be reversed by transforming the surgical procedures has yet to be established. In the hope of avoiding this kind of complication, thought to be caused by the lack of passage of a hypothetical hepatic factor through the pulmonary circulation. wedevelped an inverred type of gidirectional cavopulmonary connection in which the blood coming from the liver perfuses immediately both lungs. This is made possi-ble by shuntiong via an intra-atrial tunnel the blood from the superior caval vein directly to the left atrium, and the blood from the inferior caval vein to the right branch of the pulmonary trunk (keeping its bifurcation intact). We describe findings in two patients undergoing successful surgery with this technique. Serial follow -up with cohtrast echocardiography did not show evidence of arteriovenous pulmonary fistulas.Despite our numbers being small, and the time of follow-up being limited, we believe that it is importantto document these and similar cases

Keywords

Bidirectional cavopulmonary shuntsFontan operationpulmonary arteriovenous fistula
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 3 , July 1998 , pp. 364 - 367
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Azzolina, G, Eufrates, S, Pensa, P. Tricuspid atresia: experience in surgical management with a modified cavopulmonary anastomosis. Thorax 1972; 27 111–115.CrossRefGoogle ScholarPubMed
2.Chang, AC, Hanley, FL, Vernovsky, G, Rosenfeld, HM, Wessel, DL, Jonas, RA, Mayer, JE, Castaneda, AR. Early bidirectional cavopulmonary shunt in young infants. Circulation 1993; 88: 149–158.Google ScholarPubMed
3.Hopkins, RA, Armstrong, BE, Serwer, GA, Peterson, RG, Oldham, HN. Physiological rationale for a bidirectional cavopulmonay shunt. J Thorac Cardiovasc Surg 1985; 90: 391–398.CrossRefGoogle ScholarPubMed
4.Moore, JW, Kirby, WC, Madden, WA, Gaither, NS. Development of pulmonary arteriovenous malformations after modified Fontan operations J Thorac Cardiovasc surg 1989; 98: 1045–1050.CrossRefGoogle ScholarPubMed
5.Berstein, HS, Brook, MM, Silverman, NH, Bristow, J. Development of pulmonary arteriovenous fistulae in childern after cavopulmonary shunt Circulation 1995; 92: 309–314.CrossRefGoogle Scholar
6.Senning, A. Surgical correction of transposition of the great vessels surgery 1959; 45: 966–980.Google ScholarPubMed
7.Rosenthal, DN, Bulbul, ZR, Friedman, AH, Hellenbrand, WE, Kleinman, CS. Trombosis of the pulmonary artery stump after distal ligation J Thorac Cardiovasc Surg 1995; 110: 1563–1565.CrossRefGoogle Scholar
8.Jonas, RA. Indications and timing for the bidirectional Glenn shunt versus the fenestrated Fontan circulation J Thorac Cardiovasc Surg 1994; 108: 522–524.CrossRefGoogle ScholarPubMed
9.Webber, SA, Houvath, P, LeBlac, JG, Slavik, Z, Lamb, RKMonro, JL, Reich, O, Hruda, J, Sandor, GG, Keeton, BR. Influence of competitivepulmonary blood flow on the bidirectional superior cavopulmonary shunt. A multi-institutional study. Circulation 1995; 92: II 279–286.CrossRefGoogle ScholarPubMed
10.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 240–244.CrossRefGoogle ScholarPubMed
11.McFaul, RC, Tajik, AJ, Mair, DD, Danielson, GK, Seward, JB. Development of pulmonary arteriovenous shunt after superior vena cava-right pulmonary artery (Glenn) anastomosis. Circulation 1977; 55: 212–216.CrossRefGoogle ScholarPubMed
12.Glenn, WWL. Circulatory bypass of the right side of the heart: shunt between superior vena cava and distal right pulmonary artery – report of clinical application N Engl J Med 1958; 259: 117–120.CrossRefGoogle ScholarPubMed
13.Kawashima, W, Kitamura, S, Matsuda, H, Shimazaki, Y, Nakano, S, Hirose, H. Total cavopulmonary shunt operation in complex cardiac anomalies: a new operation. J Thorac cardiovasc Surg 1984; 87: 74–81.CrossRefGoogle ScholarPubMed
14.Srivastva, D, Preminger, T, Lock, JE, Mandell, V, Keane, JF, Mayer, JE, Kozamewich, H, Speavak, PJ. Hepatic venous blood and the development of pulmonary arteriovenous malformation in congenital heart disease. Circulation 1995; 92: 1217–1222.CrossRefGoogle Scholar
15.Macé, L, Dervanian, P, Losay, J, Folliguet, TA, Grinda, JM, Abdeelmoulah, S, Verrier, JF, Santoro, F, Neveux, JY. Bidirectional inferior vena cava-pulmonary arrtery shunt. Ann Thorac Surg 1997; 63: 1321–1325.CrossRefGoogle ScholarPubMed
16.Luisi, VS, Murzi, B, Bernabei, M, Biagini, A. Bidirectional inferior vena cava-pulmonary artery shunt (letter). J Thorac Cardiovasc Surg 1997; 107: 1367.CrossRefGoogle Scholar