bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. All patients were consid- ered less than “ideal” candidates for a Fontan . The bidirectional cavopulmonary shunt, like the classic. Glenn anastomosis, by virtue of increasing the effective pulmonary flow improves the systemic arterial. Abstract. Objectives: The bidirectional cavopulmonary (Glenn) shunt is a commonly performed procedure for a variety of cyanotic congenital.

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Incremental risk factors for late mortality were: However, the Fontan circulation carries in itself the substrates for late dysfunction of the pulmonary arterial and systemic venous circulations [ 1 ]. Articles by Fazari, L.

J Thorac Cardiovasc Surg. The distal clamp is placed proximal to the BT shunt. Survival after bidirectional cavopulmonary anastomosis: NCCT of the head was done cavopulmoary all patients one day prior to discharge. Two patients died early after HTx and three patients died from ventricular failure while on the transplant waiting list.

At the same time, it was ensured that enough length of SVC was available for anastomosis. After the Norwood procedure, patients have limited cardiac reserve if they have dominant right ventricle morphology and possible issues with coronary perfusion. Despite improvements in surgical technique and medical management, single-ventricle lesions remain one of the most challenging congenital heart anomalies to treat, and mortality rates are high.


However, nonelective timing of the BCPS, which was associated with length of stay in multivariable analysis, was associated with age.

Understanding Stage II Bidirectional Cavopulmonary Shunts

I do not know that anybody has ever had a series where they have said let’s just do cavopulmonary shunts with no extra source of flow and then let them go as long as possible. I have no clear explanation for that.

This pulmonary blood flow is optimized in sbunt presence of lower pulmonary vascular resistance and unobstructed pulmonary artery anatomy. The superior vena cava SVC was transected and anastomosed end to side to ipsilateral pulmonary bidifectional Figure.

Understanding Stage II Bidirectional Cavopulmonary Shunts

J Thorac Cardiovasc Surg ; It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide.

Clamping the SVC without decompressing the internal jugular venous system has been demonstrated to reduce cerebral perfusion pressure. Age and weights at operation averaged 5. Reproduced from Baba et al, 23 with permission from Wolters Kluwer. All patients in the bypass group had additional procedures: The risk of complications is marked, and challenges arise during staged surgical palliation.

Two patients had bilateral SVC and did not require any shunt. We all jump into the Fontan essentially as early as possible. I think everybody agrees that Fontans are not perfect, and that once you do a Fontan, the clock does start ticking. If there are other people, I will defer, but I do have a couple of other thoughts. Oxford University Press is a department of the University of Oxford.


The evolution of the Fontan procedure in a single center.

They used venoatrial or venopulmonary shunt in their series. The BCPS has become a universal intermediate staging procedure between stage I palliation and the Fontan repair in infants born with a single ventricle.

Although this issue is out of the scope of the present study, the analysis of the results in the patients who were excluded, could provide valuable information.

The bidirectional cavopulmonary shunt.

Even if widely accepted, this protocol is still a matter for discussion and many points remain controversial. Kaulitz RHofbeck M.

All the shunts were patent. The final stage involves complete separation with a total cavopulmonary connection. If the goal was to prolong things as far as possible, why did you not do an extra shunt in the other 40 to prolong things even further?