[Cavopulmonary shunts in the treatment of univentricular heart diseases in children. An experience of 60 cases].
Sixty children with a complex cardiac malformation consisting of a single functional ventricle and a protected pulmonary circulation, previously palliated by one or several Blalock anastomoses (40 cases) underwent a cavopulmonary shunt procedure. All but one had an excellent hemodynamic status: ventricular end diastolic pressure < 15 mmHg, mean pulmonary pressure < 20 mmHg, pulmonary vascular resistance < 3 units and a Mayo Clinic index (a combination of these parameters and pulmonary and systemic blood flow) < 4. The shunt was complete from the outset in the 27 most favorable cases which did not require any other surgical procedure. There were 2 immediate failures which necessitated reducing the reconstruction to a partial shunt; 9 cases were complicated by thrombosis of the intercaval connection (2 case, 1 death), by neurological complications (2 cases, 1 death), by chronic serous effusions (5 cases): of the 21 survivors followed up for a maximum of 54 months (average 28 +/- 9 months), 18 were well and 2 handicapped by venous stasis. The shunt was partial in 33 cases, especially in 17 cases because it was necessary to operate the pulmonary branches, the subaortic area, or an atrioventricular valve; there was no immediate mortality but 5 complications which were related to an associated procedure in 3 cases. There were no complications in 28 cases: of the 30 children followed up an average of 24 months, there were 3 secondary degradations (2 deaths and 1 cardiac transplantation), 10 shunts completed 2 to 32 months later with no deaths and 8 excellent results, and 17 children waiting for more favorable conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
Acar
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Service de cardiologie pédiatrique du département de pédiatrie hôpital Necker/Enfants malades, Paris.
Sidi
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Kachaner
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Gournay
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Iserin
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Da Cruz
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Delogu
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D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007223:Infant; D011651:Pulmonary Artery / Q000601:surgery*; D012086:Reoperation; D014683:Vena Cava, Superior / Q000601:surgery*
Dérivations cavopulmonaires pour traiter les cardiopathies univentriculaires de l'enfant. Une expérience de 60 cas.