Retrospective study of results of Kawashima procedure.
BACKGROUND
Patients with single ventricle physiology and an interrupted inferior caval vein undergo the Kawashima procedure. With increasing follow-up, pulmonary arteriovenous malformations may develop requiring hepatocardiac venous redirection.


METHODS
Between January 2005 and December 2012, 15 patients underwent the Kawashima procedure. Preoperative and postoperative characteristics along with functional class, intra-operative details, post-operative course, saturations and haematocrit were recorded.


RESULTS
Median age at operation was five years (range 1- 20 years). Five patients had antegrade pulmonary blood flow interrupted and 10 patients had open antegrade flow. There were no deaths. Mean saturation in postoperative period was 90.8 ±1.36%. Median duration of mechanical ventilation and inotropic support was six and 16hours respectively. Median duration of pleural drainage was six days. Median duration of pleural drainage in antegrade flow open and interrupted group was six days and four days respectively. The mean hospital stay was 10.5 days ±7.1 days. Mean follow up was 40.2 ±31 months (median-30 months). Nine patients (60%) were in New York Heart Association (NYHA) functional class 1 and five patients (33.3%) were in NYHA functional class 2 at last follow-up. Only one patient was in class 3 and needs completion Fontan.


CONCLUSIONS
The Kawashima procedure can be safely performed with acceptable early results. Although studies have shown the risk of pulmonary arteriovenous malformations after Kawashima procedure in the mid and long-term, our findings do not support this. Kawashima procedure with open antegrade pulmonary blood flow as a definite intervention in such patients is debatable.
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. Electronic address: sachintalwar@hotmail.com.
Sachin
S
Talwar
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Lokesh Shekher
LS
Jaiswal
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Shiv Kumar
SK
Choudhary
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Anita
A
Saxena
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Rajnish
R
Juneja
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Shyam Sunder
SS
Kothari
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Balram
B
Airan
D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000379:methods*; D014683:Vena Cava, Superior / Q000601:surgery*
Arteriovenous malformations; Bidirectional Glenn; Cavopulmonary connection; Cyanotic heart disease; Single ventricle