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New approach in partial cavopulmonary connection

Published online by Cambridge University Press:  19 August 2008

Paulo. P. Paulista ,
Maria Virginia. T. Santana ,
Antonio. T. M. Henriques Neto  and
Valmir F. Fontes
Paulo. P. Paulista*
Affiliation:
Departments of Cardiovasular Surgery and Pediatric Cardiology, ‘Dante pazzanese’ Institue of Cardiology, Sã paulo, Brazil
Maria Virginia. T. Santana
Affiliation:
Departments of Cardiovasular Surgery and Pediatric Cardiology, ‘Dante pazzanese’ Institue of Cardiology, Sã paulo, Brazil
Antonio. T. M. Henriques Neto
Affiliation:
Departments of Cardiovasular Surgery and Pediatric Cardiology, ‘Dante pazzanese’ Institue of Cardiology, Sã paulo, Brazil
Valmir F. Fontes
Affiliation:
Departments of Cardiovasular Surgery and Pediatric Cardiology, ‘Dante pazzanese’ Institue of Cardiology, Sã paulo, Brazil
*
Dr Paulo P Paulista, ‘Dante Pazzanese’ Institute of Cardiology, Av. Dante Pazzanese 500 – Ibirapuera, 04012-180 São Paulo – SP, Brazil. Tel: 55 11 549 1144ext 134; Fax: 55 11 571 5621
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Abstract

The development of pulmonary atteriovenous fistulas after bidirectional cavopuomonary operat-tions, such as the bidirectional Glenn shunt and Kawashima's procedure, has raised concern. Development of these fistulas, which are more frequent than initially thought, can represnt a limiting factor in the late outcome of these patients and may even limit the indication for these of surgery. Whether the fistulas can be reversed by transforming the surgical procedures has yet to be established. In the hope of avoiding this kind of complication, thought to be caused by the lack of passage of a hypothetical hepatic factor through the pulmonary circulation. wedevelped an inverred type of gidirectional cavopulmonary connection in which the blood coming from the liver perfuses immediately both lungs. This is made possi-ble by shuntiong via an intra-atrial tunnel the blood from the superior caval vein directly to the left atrium, and the blood from the inferior caval vein to the right branch of the pulmonary trunk (keeping its bifurcation intact). We describe findings in two patients undergoing successful surgery with this technique. Serial follow -up with cohtrast echocardiography did not show evidence of arteriovenous pulmonary fistulas.Despite our numbers being small, and the time of follow-up being limited, we believe that it is importantto document these and similar cases

Keywords

Bidirectional cavopulmonary shuntsFontan operationpulmonary arteriovenous fistula
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 3 , July 1998 , pp. 364 - 367
Copyright
Copyright © Cambridge University Press 1998

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