title: Can the Kawashima procedure be performed in younger patients?
abstract: BACKGROUND
  The prudence of performing early palliative cavopulmonary connection that includes superior vena cava in association with azygous-hemiazygous continuation of the inferior vena cava, Kawashima procedure (KP), has been questioned. We document our experience with KP performed at a relatively younger age than usually reported.
  
  
  METHODS
  A retrospective review of patients undergoing KP (October 2000 to April 2008) was done.
  
  
  RESULTS
  Initial palliation was carried out in 13 of 15 patients. Age and weight at KP was 8.4 months (5.1 to 15.1) and 6.8 kg (4.6 to 11.0). The pre-KP catheterization showed the following: pulmonary artery pressure = 14.5 mm Hg (9 to 17); end-diastolic pressure of systemic ventricle = 8 (2 to 14); oxygenation saturation = 76% (63 to 82); and atrioventricular (AV) valve insufficiency moderate or greater in 5 patients. The post-KP characteristics included the following intubation = 1 day (0 to 19); nitric oxide = 4 patients; superior caval pressure = 14 mm Hg (6 to 18); inotrope score = 7.5 (2.5 to 14.3); intensive care unit stay = 3 days (1 to 9); hospital stay = 7 days (3 to 77); and oxygen saturation at discharge = 84% (76 to 90%). There was one hospital death that required takedown of KP. Fontan completion was performed in 8 patients at an interval of 2.7 years (1.8 to 5.8) after KP. There was one post-Fontan mortality from severe ventricular and AV valve dysfunction. Pulmonary arteriovenous malformations (PAVMs) were diagnosed in 4 patients with 3 resolving post-Fontan. With a median follow-up of 4.2 years (0.1 to 7.9), 13 of 15 remain alive yielding a series survival of 87%.
  
  
  CONCLUSIONS
  The Kawashima procedure can be safely performed at an earlier age than previously reported. The incidence of PAVMs after the KP appears to be similar to other reports where KP was performed at a later age.
authors.affiliation: Division of Cardiothoracic Surgery, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Dilip S
authors.initials: DS
authors.lastname: Nath
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Carden
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nussbaum
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Shin
authors.forename: Robinder G
authors.initials: RG
authors.lastname: Khemani
authors.forename: Vaughn A
authors.initials: VA
authors.lastname: Starnes
authors.forename: Winfield J
authors.initials: WJ
authors.lastname: Wells
mesh_terms: D001165:Arteriovenous Malformations / Q000209:etiology; D006328:Cardiac Catheterization; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D018579:Patient Selection; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery*; D012189:Retrospective Studies; D014682:Vena Cava, Inferior / Q000002:abnormalities / Q000601:surgery*