title: Bidirectional cavopulmonary shunt in patients with multiple risk factors.
abstract: BACKGROUND
  Twenty-five patients in whom a modified Fontan operation was deferred because of multiple risk factors underwent a bidirectional cavopulmonary shunt. Two or more of the following risk factors were present in all: age less than 1 year, severe pulmonary artery distortion, impaired left ventricular function, subaortic obstruction, anomalous systemic-pulmonary venous connection, atrioventricular valve incompetence, and increased mean pulmonary artery pressure.
  
  
  METHODS
  Additional procedures included take-down of systemic-pulmonary artery shunt, atrial septectomy, pulmonary artery reconstruction, bulboventricular foramen enlargement, and atrioventricular valve repair.
  
  
  RESULTS
  There were three hospital deaths (12%). Mean follow-up is 21 months. There was no late mortality. Mean oxygen saturation increased from 71% to 83%. Results obtained from pulmonary artery reconstruction, enlargement of bulboventricular foramen, and atrioventricular valve repair were satisfactory for the patients in whom these risk factors were present preoperatively. Ventricular function also improved in the survivors in whom it was previously deteriorated, this being related to the suppression of the sources of ventricular volume overload.
  
  
  CONCLUSIONS
  In this risk group of patients for a modified Fontan operation, a bidirectional cavopulmonary shunt provided adequate palliation at reasonable low risk. Early bidirectional cavopulmonary shunt would minimize complications originating from systemic-pulmonary shunts such as pulmonary artery distortion and the potential harm of chronic ventricular volume overload.
authors.affiliation: Unit of Pediatric Cardiovascular Surgery, Hospital Italiano, Buenos Aires, Argentina.
authors.forename: F J
authors.initials: FJ
authors.lastname: Vargas
authors.forename: G
authors.initials: G
authors.lastname: Mengo
authors.forename: J P
authors.initials: JP
authors.lastname: Gallo
authors.forename: C B
authors.initials: CB
authors.lastname: Skerl
authors.forename: M E
authors.initials: ME
authors.lastname: Ranzzini
authors.forename: J C
authors.initials: JC
authors.lastname: Vazquez
mesh_terms: D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D018610:Heart Bypass, Right / Q000379:methods*; D006330:Heart Defects, Congenital / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D010166:Palliative Care; D012307:Risk Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications