Iorio and carlo marcelletti bidirectional cavopulmonary anastomosis may either be performed as part of a total cavopulmonary connec tion or as a palliative procedure in a staged approach towards the fontan operation. The bidirectional glenn shunt procedure involves rerouting circulation such that the superior vena cava svc drains into the right pulmonary artery. Highrisk candidates who have undergone the bidirectional glenn procedure bdg before. The physiology of the bidirectional cavopulmonary connection. Pdf bidirectional cavopulmonary shunt associated with. Pdf between june 1997 and july 2000, 170 patients aged 0. The bidirectional cavopulmonary shunt improves systemic arterial oxygen saturation without.
Bidirectional cavopulmonary anastomosis bcpa is an important preliminary. The bidirectional glenn shunt for univentricular hearts. The bidirectional cavopulmonary glenn shunt is almost a routine first step procedure for total cavopulmonary connection in children with singleventricle cardiac anomalies. Pdf outcomes after bidirectional cavopulmonary shunt in. Article information, pdf download for the superior cavopulmonary connection. Bidirectional cavopulmonary shunt using the azygos vein. Bidirectional superior cavopulmonary connection bcpc is a widely used method of providing pulmonary blood flow in patients with complex congenital cardiac malformations characterised by univentricular atriovenous connections 1,2,3. Besides being used as an intermediate stage between systemictopulmonary artery shunt or pulmonary artery band and fontan procedure it. During this operation, the superior vena cava was divided and we performed cavopulmonary. Physiological rationale for a bidirectional cavopulmonary. Objective to evaluate the extent of intrapulmonary right to left shunting in children after bidirectional cavopulmonary anastomosis bcpa. Residual tricuspid valve insufficiency rate was 26% in both groups.
Right internal jugular vein cannulation was avoided because any stenosis of the superior vena cava would prove extremely detrimental in infants with single ventricle physiology as the preferred palliation would most likely be staged bidirectional cavopulmonary shunt glenn and total cavopulmonary anastomosis fontan procedures. There have been no bidirectional cavopulmonary shunt failures, stenoses, kinks, or recognized pulmonary arteriovenous malformations. Ninetyfive patients underwent a bidirectional cavopulmonary shunt between 1995 and 1999. Design prospective study of patients who underwent bcpa in a single centre. Understanding stage ii bidirectional cavopulmonary shunts. Outcomes after bidirectional cavopulmonary shunt in. The semifontan, journal of the american college of cardiology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at. Our results have demonstrated that patients after bbcpa might have a tendency for worse outcomes upon fontan completion. The bidirectional glenn shunt remains an excellent palliative procedure as a. Systemic venous collateral channels causing desaturation. The principal indication for a bidirectional superior cavopulmonary shunt today is as staging towards a total cavopulmonary connection after. Bidirectional glenn procedure nicklaus childrens hospital. The unifocal bilateral bidirectional cavopulmonary anastomosis. For example, it may be done after the removal of the bt shunt or pulmonary artery banding.
On the contrary, bidirectional cavopulmonary shunt release the single ventricle from pulmonary circulation. From a theoretical point of view, a bidirectional cavopulmonary shunt bcps associated with a wellcalibrated source of additional pulmonary blood flow apbf should yield such a favourable haemodynamic status. Hepatoazygos venous shunt for fontan completion after kawashima operation. The bidirectional cavopulmonary glenn shunt is a commonly performed procedure for a variety of cyanotic congenital heart diseases that lead eventually to a single ventricle repair. Patients 17 patients with complex cyanotic congenital cardiac malformations who underwent bcpa at 145 months of age median 21 months were evaluated 1564 months. Influence of competitive pulmonary blood flow on the. Outcomes after bidirectional cavopulmonary shunt in infants less than 6 months old v. The bidirectional cavopulmonary connection in the strategies employed to improve the outcome of the fontan operation, many now advocate staging with a bidirectional cavopulmonary connection, the socalled hemifontan procedure 1216.
Group 1 n 38 had a shunt without an additional source of pulmonary blood flow. Combined construction of bidirectional cavopulmonary and. All patients were considered less than ideal candidates for a fontan procedure. Early bidirectional cavopulmonary shunt in young infants.
Most centers have adopted this strategy, including our own. Karl the use of the bidirectional cavopulmonary shunt has had a favorable effect on the outcome of surgery for hypoplastic left heart syndrome. These patients are especially vulnerable to reduced tissue oxygenation, and. All patients were consid ered less than ideal candidates for a fontan. Since 1983, 17 patients have undergone a cavopulmonary shunt procedure five primary operations, 12 secondary operations.
Bcpc was initially considered free of the problems associated with the classical glenn anastomosis. Interactive cardiovascular and thoracic surgery systemic haemodynamics and regional tissue oxygen saturation after bidirectional cavopulmonary shunt. The principal indication for a bidirectional superior cavopulmonary shunt today is as staging towards a total cavopulmonary connection after which total exclusion of a deficientinsufficient right ventricle is achieved with complete elimination of mixing between the. Bidirectional cavopulmonary shunt with accessory pulmonary. Intrapulmonary arteriovenous shunting may be a universal. Cavopulmonary shunt definition of cavopulmonary shunt by. The first surgery to separate pulmonary and systemic blood flow is the bidirectional cavopulmonary shunt. Bidirectional cavopulmonary shunt and fontan repair are now commonly performed in patients with a variety of forms of complex single ventricle, including those with anomalies of systemic or pulmonary venous return. The bilateral bidirectional glenn operation as a risk. Objectiveto define the lowest age at which the bidirectional superior cavopulmonary anastomosis can safely be used in infants with complex congenital heart defects. Upon completion of the bidirectional cavopulmonary shunt operation, we addressed the stenotic lesions of the superior vena cava and left pulmonary artery, and a markedly expanded azygos vein. The bidirectional cavopulmonary shunt for hypoplastic left heart syndrome tom r. Hepatoazygos venous shunt for fontan completion after.
As a result, often this shunt is a shortterm, palliative procedure performed in young children usually cavopulmonary anastomosis glenn procedure by sickkids staff. Current approach for cavopulmonary connection fiore s. Somewhat simpler than the hemifontan from a technical standpoint, a bidirectional glenn does not address pulmonary artery hypoplasia or distortion by augmenting the pulmonary artery confluence, does not maintain the. This surgery allows deoxygenated, blue blood from the head to drain passively to lungs. We sought to characterize the frequency, anatomic details and factors associated with the development of collateral channels between the superior and inferior vena caval systems after bidirectional cavopulmonary anastomosis. This study was undertaken to evaluate longterm results of biventricular repairs for congenitally corrected transposition of the great arteries, and t. These anomalies are ideally dealt with during bidirectional cavopulmonary shunt, thereby. Therefore, we examined the outcomes of bcps in infants younger than 3 months of age. Bidirectional cavopulmonary shunt bcps has played an important role in the staged fontan approach. We report a case of tricuspid atresia patient who underwent first palliative surgery and second. T he traditional approach to the child with a single ventricle over the past 20 years has been a neonatal pal. Pulmonary artery indices, including the lower lobe index, do not change significantly after bidirectional cavopulmonary shunt during mediumterm followup and do not influence the fontan outcome.
Outcomes after bidirectional cavopulmonary shunt in infants less than 6 months old. The bidirectional cavopulmonary shunt improves systemic arterial oxygen saturation without increasing ventricular work or pulmonary vascular resistance. The bidirectional cavopulmonary shunt may be defined as an operation that diverts the systemic venous return from the superior vena cava or cavae to both lungs. Even though creation of a bidirectional cavopulmonary shunt or completion of the fontan circulation carries a relatively low risk in the current era, 9 perioperative management is challenging, and morbidity remains considerable. The fontan procedure was initially described in 1971 by dr. The bidirectional glenn shunt for univentricular hearts springerlink.
Group 2 n 57 had a shunt with accessory pulmonary flow. No deleterious effects of the bidirectional cavopulmonary shunts were observed clinically. Influence of competitive pulmonary blood flow on the bidirectional superior cavopulmonary shunt. Article information, pdf download for risk factors for unfavorable outcomes after. Analytical identification of ideal pulmonarysystemic flow. Designa retrospective analysis of clinical, echocardiographic, haemodynamic, and angiographic. Indications and timing for the bidirectional glenn shunt versus the fenestrated fontan circulation richard a. Besides being used as an intermediate stage between systemictopulmonary artery shunt or pulmonary artery band and fontan procedure it has. Bidirectional cavopulmonary shunt in patients with. This article describes singleventricle lesions and gives a basic overview of outcomes and strategies to improve interstage mortality. We report our experience in 18 patients with such disease who underwent a bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. Combined construction of bidirectional cavopulmonary and aortopulmonary shunts as an intermediate stage in the repair of an 18yearold highrisk fontan candidate volume 6 issue 1 masaaki yamagishi, hiromi kurosawa, kazuhiro hashimoto. It is needed when one of the hearts ventricles doesnt work well.
Postoperatively, eight patients had assessment of pulmonary distribution of shunt blood flow by. Prior to this, the surgical treatment for tricuspid atresia consisted of creating a shunt between a systemic artery and the pulmonary artery blalocktaussig shunt or the superior vena cava and the. Alternatively, the bidirectional glenn is another option to construct a superior cavopulmonary anastomosis figures 712. Bidirectional glenn procedure is one in a series of surgeries performed to get a sufficient amount of blood to the lungs. The bidirectional glenn procedure can also lead to systemic venous collateral vessels and pulmonary arteriovenous malformations. Indications and timing for the bidirectional glenn shunt. However, patients with the bidirectional cavopulmonary shunt had a better tolerance and have not needed reoperations to date. This procedure tends to be done as an openheart procedure. Pdf on jul 1, 2008, anil bhan and others published offpump bidirectional. The role of bidirectional cavopulmonary anastomosis for palliation of complex cyanotic congenital heart disease is widely recognized.
The bidirectional cavopulmonary shunt for hypoplastic left. Energetic performance analysis of staged palliative. Bidirectional glenn shunt cavopulmonary shunt bdg the bidirectional glenn shunt dg is often the second procedure done in the pathway of single ventricle palliation. The remaining 19 patients have been followed up for 2 months to 9 years with one late sudden death at 9 years. Quantification of collateral aortopulmonary flow in. Glenn anastomosis, by virtue of increasing the effective pulmonary flow improves the systemic arterial. It is well known that systemic venous collateral channels often develop in patients who have undergone a classic glenn shunt or. Risk factors for unfavorable outcomes after bidirectional. We proposed, in the late 1980s, the hypothesis that bcps with apbf may provide a longlasting, and potentially, definitive palliation. The kawashima operation is a bidirectional superior cavopulmonary shunt performed for first stage palliation of single ventricle patients with interruption of inferior vena cavaivc. Bidirectional cavopulmonary shunt associated with ventriculo and valvuloplasty in ebsteins anomaly.
The median age at bidirectional cavopulmonary shunt was 1. The fontan operation starts with the cavopulmonary shunt. Students corner bidirectional cavopulmonary shunt for. This results in deoxygenated blood returning from the head and upper body directly routed to the pulmonary arteries for oxygenation by the lungs, to some extent reducing the ventricular workload. Blalocktaussig shunt necessitates a single ventricle eject blood to both the systemic and pulmonary circulation. Survival is not influenced by age at bidirectional cavopulmonary shunt surgery, left or right functional ventricular. The bbcpa is associated with pulmonary artery bifurcation stenosis and presents multiple sources of pulmonary blood flow where conventional pvr calculation might be imprecise and misleading since it considers the lungs as a single unit.