Bidirectional inferior vena cava-pulmonary artery shunt.
BACKGROUND
Bidirectional superior vena cava-pulmonary shunt is widely used as an interim palliation for patients with univentricular hearts. Bidirectional inferior vena cava-pulmonary artery shunt, as an alternative approach of partial Fontan circulation, may offer the advantage of performing the complete Fontan circulation more easily due to the already constructed inferior vena cava lateral tunnel.


METHODS
We used bidirectional inferior vena cava-pulmonary artery shunt in 2 patients. Contraindications to a complete Fontan circulation were due to, respectively, a volume-overloaded systemic ventricle and an irregular pulmonary arterial tree.


RESULTS
Postoperative courses were uneventful. There were no significant pleural effusions. Transcutaneous oxygen saturations were 77% and 78%. Pulmonary-to-systemic blood flow ratios were 0.57 and 0.63. A complete Fontan circulation was safely performed 8 and 12 months later, without any "Fontan-related" complications.


CONCLUSIONS
Bidirectional inferior vena cava-pulmonary artery shunt can be useful in selected patients with univentricular hearts, although its place in the field of "partial Fontan operations" cannot be determined as yet.
Macé
L
L
Department of Cardiovascular and Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Paris-Sud University, Paris, France.
Dervanian
P
P
Losay
J
J
Folliguet
T A
TA
Grinda
J M
JM
Abdelmoulah
S
S
Verrier
J F
JF
Santoro
F
F
Neveux
J Y
JY
D005069:Evaluation Studies as Topic; D018729:Fontan Procedure; D018611:Heart Bypass, Left / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010166:Palliative Care