As originally published in 1996. Usefulness of pulsatile bidirectional cavopulmonary shunt in high-risk Fontan patients. Updated in 2002.
BACKGROUND
A bidirectional cavopulmonary shunt has been performed for the high-risk Fontan patient. It is well known that in the presence of the bidirectional cavopulmonary shunt alone to secure pulmonary blood flow, the central pulmonary artery size decreases over time. We have performed pulsatile bidirectional cavopulmonary shunt (PBCPS), keeping pulmonary blood flow from the ventricle through the stenotic pulmonary valve, or a Blalock-Taussig shunt in patients who do not meet the criteria for the Fontan operation.


METHODS
Eleven patients who underwent PBCPS between 1989 and 1993 were reviewed. We compared the results of cardiac catheterization immediately before PBCPS and during the postoperative observation period (310 +/- 257 days).


RESULTS
Pulmonary blood flow and arterial oxygen saturation increased significantly after PBCPS (p = 0.01). Pumonary artery area index showed a tendency to increase (p = 0.11). The mean number of risk factors for the Fontan procedure decreased significantly from 1.8 +/- 1.1 to 0.7 +/- 0.8 after PBCPS (p < 0.05). Overall, 5 of the 11 patients (45.5%) met the criteria for the Fontan procedure, and a fenestrated Fontan procedure was carried out in 4 of them.


CONCLUSIONS
The PBCPS is useful for high-risk Fontan patients not only in the staged Fontan operation, but also as definitive palliation.
Miyaji
Kagami
K
Shimada
Munehiro
M
Sekiguchi
Akihiko
A
Ishizawa
Akira
A
Isoda
Takayoshi
T
D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018610:Heart Bypass, Right / Q000379:methods*; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology*; D011652:Pulmonary Circulation / Q000502:physiology; D011673:Pulsatile Flow / Q000502:physiology; D015996:Survival Rate; D014655:Vascular Resistance / Q000502:physiology