We report a case of tricuspid atresia patient who underwent first palliative surgery and second. Right internal jugular vein cannulation was avoided because any stenosis of the superior vena cava would prove extremely detrimental in infants with single ventricle physiology as the preferred palliation would most likely be staged bidirectional cavopulmonary shunt glenn and total cavopulmonary anastomosis fontan procedures. The kawashima operation is a bidirectional superior cavopulmonary shunt performed for first stage palliation of single ventricle patients with interruption of inferior vena cavaivc. Bidirectional cavopulmonary shunt associated with ventriculo and valvuloplasty in ebsteins anomaly. Residual tricuspid valve insufficiency rate was 26% in both groups. The bidirectional glenn shunt remains an excellent palliative procedure as a.
Bidirectional cavopulmonary shunt using the azygos vein. Article information, pdf download for risk factors for unfavorable outcomes after. Survival is not influenced by age at bidirectional cavopulmonary shunt surgery, left or right functional ventricular. Designa retrospective analysis of clinical, echocardiographic, haemodynamic, and angiographic. The bbcpa is associated with pulmonary artery bifurcation stenosis and presents multiple sources of pulmonary blood flow where conventional pvr calculation might be imprecise and misleading since it considers the lungs as a single unit.
This study was undertaken to evaluate longterm results of biventricular repairs for congenitally corrected transposition of the great arteries, and t. Prior to this, the surgical treatment for tricuspid atresia consisted of creating a shunt between a systemic artery and the pulmonary artery blalocktaussig shunt or the superior vena cava and the. Bidirectional glenn procedure is one in a series of surgeries performed to get a sufficient amount of blood to the lungs. Pulmonary artery indices, including the lower lobe index, do not change significantly after bidirectional cavopulmonary shunt during mediumterm followup and do not influence the fontan outcome. Indications and timing for the bidirectional glenn shunt versus the fenestrated fontan circulation richard a. Bidirectional cavopulmonary shunt in patients with. Influence of competitive pulmonary blood flow on the bidirectional superior cavopulmonary shunt. Outcomes after bidirectional cavopulmonary shunt in infants less than 6 months old. The principal indication for a bidirectional superior cavopulmonary shunt today is as staging towards a total cavopulmonary connection after which total exclusion of a deficientinsufficient right ventricle is achieved with complete elimination of mixing between the. This surgery allows deoxygenated, blue blood from the head to drain passively to lungs. The role of bidirectional cavopulmonary anastomosis for palliation of complex cyanotic congenital heart disease is widely recognized. The physiology of the bidirectional cavopulmonary connection.
Bidirectional glenn procedure nicklaus childrens hospital. Indications and timing for the bidirectional glenn shunt. The remaining 19 patients have been followed up for 2 months to 9 years with one late sudden death at 9 years. Combined construction of bidirectional cavopulmonary and aortopulmonary shunts as an intermediate stage in the repair of an 18yearold highrisk fontan candidate volume 6 issue 1 masaaki yamagishi, hiromi kurosawa, kazuhiro hashimoto.
Glenn anastomosis, by virtue of increasing the effective pulmonary flow improves the systemic arterial. Bidirectional cavopulmonary shunt with accessory pulmonary. Energetic performance analysis of staged palliative. The bidirectional cavopulmonary shunt for hypoplastic left. The bidirectional cavopulmonary shunt improves systemic arterial oxygen saturation without. Bidirectional cavopulmonary shunt bcps has played an important role in the staged fontan approach. The fontan procedure was initially described in 1971 by dr. The bidirectional cavopulmonary connection in the strategies employed to improve the outcome of the fontan operation, many now advocate staging with a bidirectional cavopulmonary connection, the socalled hemifontan procedure 1216. Ninetyfive patients underwent a bidirectional cavopulmonary shunt between 1995 and 1999. Early bidirectional cavopulmonary shunt in young infants. We proposed, in the late 1980s, the hypothesis that bcps with apbf may provide a longlasting, and potentially, definitive palliation. Influence of competitive pulmonary blood flow on the. Intrapulmonary arteriovenous shunting may be a universal.
Backgrounda total cavopulmonary connection tcpc is a widely performed surgical. All patients were consid ered less than ideal candidates for a fontan. Even though creation of a bidirectional cavopulmonary shunt or completion of the fontan circulation carries a relatively low risk in the current era, 9 perioperative management is challenging, and morbidity remains considerable. Iorio and carlo marcelletti bidirectional cavopulmonary anastomosis may either be performed as part of a total cavopulmonary connec tion or as a palliative procedure in a staged approach towards the fontan operation. Bidirectional superior cavopulmonary connection bcpc is a widely used method of providing pulmonary blood flow in patients with complex congenital cardiac malformations characterised by univentricular atriovenous connections 1,2,3. Physiological rationale for a bidirectional cavopulmonary. The bidirectional cavopulmonary shunt may be defined as an operation that diverts the systemic venous return from the superior vena cava or cavae to both lungs.
The median age at bidirectional cavopulmonary shunt was 1. The bidirectional cavopulmonary glenn shunt is a commonly performed procedure for a variety of cyanotic congenital heart diseases that lead eventually to a single ventricle repair. The fontan operation starts with the cavopulmonary shunt. Group 1 n 38 had a shunt without an additional source of pulmonary blood flow.
Bidirectional cavopulmonary anastomosis bcpa is an important preliminary. Current approach for cavopulmonary connection fiore s. No deleterious effects of the bidirectional cavopulmonary shunts were observed clinically. As a result, often this shunt is a shortterm, palliative procedure performed in young children usually cavopulmonary anastomosis glenn procedure by sickkids staff. Rosenfeld hm, wessel dl, jonas ra, mayer je jr, lock je, castaneda ar. Objective to evaluate the extent of intrapulmonary right to left shunting in children after bidirectional cavopulmonary anastomosis bcpa.
Our results have demonstrated that patients after bbcpa might have a tendency for worse outcomes upon fontan completion. The bidirectional glenn shunt for univentricular hearts springerlink. The bidirectional cavopulmonary shunt improves systemic arterial oxygen saturation without increasing ventricular work or pulmonary vascular resistance. Bcpc was initially considered free of the problems associated with the classical glenn anastomosis. It is needed when one of the hearts ventricles doesnt work well. Systemic venous collateral channels causing desaturation. Hepatoazygos venous shunt for fontan completion after kawashima operation. Group 2 n 57 had a shunt with accessory pulmonary flow. Highrisk candidates who have undergone the bidirectional glenn procedure bdg before. Interactive cardiovascular and thoracic surgery systemic haemodynamics and regional tissue oxygen saturation after bidirectional cavopulmonary shunt. We report our experience in 18 patients with such disease who underwent a bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. Pdf between june 1997 and july 2000, 170 patients aged 0.
Most centers have adopted this strategy, including our own. Pdf outcomes after bidirectional cavopulmonary shunt in. This results in deoxygenated blood returning from the head and upper body directly routed to the pulmonary arteries for oxygenation by the lungs, to some extent reducing the ventricular workload. Therefore, we examined the outcomes of bcps in infants younger than 3 months of age. The unifocal bilateral bidirectional cavopulmonary anastomosis. The bilateral bidirectional glenn operation as a risk. All patients were considered less than ideal candidates for a fontan procedure. This procedure tends to be done as an openheart procedure. Patients 17 patients with complex cyanotic congenital cardiac malformations who underwent bcpa at 145 months of age median 21 months were evaluated 1564 months. Combined construction of bidirectional cavopulmonary and. This article describes singleventricle lesions and gives a basic overview of outcomes and strategies to improve interstage mortality. Karl the use of the bidirectional cavopulmonary shunt has had a favorable effect on the outcome of surgery for hypoplastic left heart syndrome. Analytical identification of ideal pulmonarysystemic flow.
Bidirectional cavopulmonary shunt and fontan repair are now commonly performed in patients with a variety of forms of complex single ventricle, including those with anomalies of systemic or pulmonary venous return. From a theoretical point of view, a bidirectional cavopulmonary shunt bcps associated with a wellcalibrated source of additional pulmonary blood flow apbf should yield such a favourable haemodynamic status. Design prospective study of patients who underwent bcpa in a single centre. Risk factors for unfavorable outcomes after bidirectional. Hepatoazygos venous shunt for fontan completion after. Objectiveto define the lowest age at which the bidirectional superior cavopulmonary anastomosis can safely be used in infants with complex congenital heart defects. The bidirectional cavopulmonary shunt, like the classic. The bidirectional glenn and hemifontan procedures have im.
Read the bidirectional cavopulmonary shunt in young patients with interrupted inferior vena cava. There have been no bidirectional cavopulmonary shunt failures, stenoses, kinks, or recognized pulmonary arteriovenous malformations. Outcomes of bidirectional cavopulmonary shunt in patients. The bidirectional glenn shunt bdg is often the second procedure done in the pathway of. Bidirectional glenn shunt cavopulmonary shunt bdg the bidirectional glenn shunt dg is often the second procedure done in the pathway of single ventricle palliation.
Besides being used as an intermediate stage between systemictopulmonary artery shunt or pulmonary artery band and fontan procedure it has. The bidirectional glenn shunt procedure involves rerouting circulation such that the superior vena cava svc drains into the right pulmonary artery. Outcomes after bidirectional cavopulmonary shunt in. However, patients with the bidirectional cavopulmonary shunt had a better tolerance and have not needed reoperations to date. Alternatively, the bidirectional glenn is another option to construct a superior cavopulmonary anastomosis figures 712. During this operation, the superior vena cava was divided and we performed cavopulmonary. Understanding stage ii bidirectional cavopulmonary shunts. The semifontan, journal of the american college of cardiology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at. Article information, pdf download for the superior cavopulmonary connection. Cavopulmonary shunt definition of cavopulmonary shunt by.
It is well known that systemic venous collateral channels often develop in patients who have undergone a classic glenn shunt or. The bidirectional glenn shunt for univentricular hearts. The bidirectional cavopulmonary shunt for hypoplastic left heart syndrome tom r. These anomalies are ideally dealt with during bidirectional cavopulmonary shunt, thereby. Somewhat simpler than the hemifontan from a technical standpoint, a bidirectional glenn does not address pulmonary artery hypoplasia or distortion by augmenting the pulmonary artery confluence, does not maintain the. The principal indication for a bidirectional superior cavopulmonary shunt today is as staging towards a total cavopulmonary connection after. Pdf bidirectional cavopulmonary shunt associated with. The first surgery to separate pulmonary and systemic blood flow is the bidirectional cavopulmonary shunt. We sought to characterize the frequency, anatomic details and factors associated with the development of collateral channels between the superior and inferior vena caval systems after bidirectional cavopulmonary anastomosis. On the contrary, bidirectional cavopulmonary shunt release the single ventricle from pulmonary circulation.
Outcomes after bidirectional cavopulmonary shunt in infants less than 6 months old v. Besides being used as an intermediate stage between systemictopulmonary artery shunt or pulmonary artery band and fontan procedure it. We sought to assess the results after bidirectional cavopulmonary shunt bcps in infants cavopulmonary shunt for acute right ventricular failure in an adult patient. Students corner bidirectional cavopulmonary shunt for. These patients are especially vulnerable to reduced tissue oxygenation, and. Upon completion of the bidirectional cavopulmonary shunt operation, we addressed the stenotic lesions of the superior vena cava and left pulmonary artery, and a markedly expanded azygos vein. Since 1983, 17 patients have undergone a cavopulmonary shunt procedure five primary operations, 12 secondary operations. Blalocktaussig shunt necessitates a single ventricle eject blood to both the systemic and pulmonary circulation. In this chapter, the physiology, indications, and technical aspects.
Bidirectional glenn shunt, cavopulmonary shunt, off pump surgery. Postoperatively, eight patients had assessment of pulmonary distribution of shunt blood flow by. For example, it may be done after the removal of the bt shunt or pulmonary artery banding. The bidirectional glenn procedure can also lead to systemic venous collateral vessels and pulmonary arteriovenous malformations. T he traditional approach to the child with a single ventricle over the past 20 years has been a neonatal pal.
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