Superior vena cava to pulmonary artery anastomosis: an adjunct to biventricular repair.
From May 1981 to September 1995, 38 patients received a superior vena cava-pulmonary artery anastomosis in association with biventricular repair. Patients were divided into four groups on the basis of indication for operation. Group A (19 patients) had a small physiologic right ventricle defined by tricuspid anulus z values or predicted right ventricular volume. Group B (11 patients) had a functionally compromised right ventricle. Group C (four patients) consisted of those receiving a superior vena cava-pulmonary artery anastomosis as a facilitation to biventricular repair. Group D (four patients) was defined by acute postoperative right ventricular dysfunction. Age ranged from 5 months to 51 years (median 3.5 years). There were 14 different underlying primary diagnoses in this cohort and multiple associated anomalies. Operative mortality was as follows: group A, two of 19 (10.5%); group B, two of 11 (18%); group C, none of four (0%); and group D, three of four (75%). Follow-up is complete in 37 of 38 patients (97%), ranging from 1 to 174 months (mean 46.3 +/- 36.9). Twenty-two patients are in New York Heart Association functional class I and eight patients are in class II. No clinical evidence of cyanosis or protein-losing enteropathy has been detected. With the use of this adjunctive approach, acceptable intermediate-term outcomes were obtained in patients having an anatomically or functionally compromised pulmonary ventricle. The anastomosis safely facilitates repair in a subset of patients. Results for this procedure when used as a salvage operation for right ventricular dysfunction have not been satisfactory.
Division of Cardiovascular Surgery, Hospital for Sick Children Toronto, Ontario, Canada.
G S
GS
Van Arsdell
W G
WG
Williams
C M
CM
Maser
K S
KS
Streitenberger
I M
IM
Rebeyka
J G
JG
Coles
R M
RM
Freedom
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000601:surgery*