title: Improved management of systemic venous anomalies in a single ventricle: New rationale.
abstract: OBJECTIVE
  Two innovative surgical approaches addressing systemic venous anomalies in single-ventricle patients are evaluated.
  
  
  METHODS
  Between 2003 and 2007, 7 patients underwent a unifocal bilateral bidirectional cavopulmonary anastomosis, and 5 patients underwent a hepatoazygos venous connection associated with a previous (n = 4) or concomitant (n = 1) Kawashima operation. Computational fluid dynamics simulations allowed investigation of 2 sets of comparative models: (1) bifocal versus unifocal bilateral bidirectional cavopulmonary anastomosis and (2) classic hepatic vein-pulmonary artery channel versus hepatoazygos direct anastomosis for Fontan completion after or combined with the Kawashima operation.
  
  
  RESULTS
  There was 1 hospital death in the unifocal bilateral bidirectional cavopulmonary anastomosis group. At a mean follow-up of 15.6 +/- 7.40 months after a unifocal bilateral bidirectional cavopulmonary anastomosis and of 38.7 +/- 13.2 months after direct hepatoazygos venous connection, respectively, all 11 survivors are in New York Heart Association class I with functional anastomoses. Computational assessment of bifocal bilateral bidirectional cavopulmonary anastomosis demonstrated weak perfusion between caval veins against symmetric and steady bilateral flow fields in the unifocal arrangement. In the classic post-Kawashima Fontan completion model, the hepatic venous flow to the pulmonary artery was held back by means of preponderant opposite flow, whereas in the direct hepatoazygos venous connection model, the hepatic venous flow merged smoothly into the azygos vein. Power-loss calculation showed no significant difference between bifocal and unifocal bilateral bidirectional cavopulmonary anastomosis topology, whereas the hepatoazygos connection clearly had better energy preservation than the classical connection.
  
  
  CONCLUSIONS
  This limited clinical and computational fluid dynamics assessment suggests the efficacy of this new rationale to reduce the additional thrombotic risks produced by systemic venous anomalies in single-ventricle patients.
authors: Cardiac Surgery Service of the Medical-Surgical Department of Paediatric Cardiology, Bambino Gesù Paediatric Hospital, Piazza S. Onofrio 4, Rome, Italy. antonioamodeo@yahoo.it
authors: Antonio
authors: A
authors: Amodeo
authors: Mauro
authors: M
authors: Grigioni
authors: Sergio
authors: S
authors: Filippelli
authors: Maria Giulia
authors: MG
authors: Gagliardi
authors: Costantino
authors: C
authors: Del Gaudio
authors: Umberto
authors: U
authors: Morbiducci
authors: Giuseppe
authors: G
authors: D'Avenio
authors: Gianluca
authors: G
authors: Brancaccio
authors: Roberto M
authors: RM
authors: Di Donato
mesh_terms: D000714:Anastomosis, Surgical; D001401:Azygos Vein; D001783:Blood Flow Velocity; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D017023:Coronary Angiography; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery; D006503:Hepatic Veins; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities; D011667:Pulmonary Veins / Q000002:abnormalities; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000000981:diagnostic imaging