A Clinical Study of Bidirectional Cavopulmonary Shunt

양방향성 상대정맥-폐동맥 단락술의 임상적 연구

  • Published : 1995.08.01

Abstract

We reviewed our experiences on 33 patients who underwent a bidirectional cavopulmonary shunt[BCPS from February 1992 to July 1994. There were 19 male an 14 female patients, and their weight ranged from 4.4 to 13.3 Kg[mean weight 8.4 $\pm$2.9 Kg . The age ranged from 2 to 55 months [mean age 16.7 $\pm$15.5 months . Their diagnosis included single ventricle group in 16, unbalanced ventricles in 8 whose associated anomalies were double outlet right ventricle, transposition of great arteries and total anomalous pulmonary venous return, tricuspid atresia in 7, hypoplastic left heart syndrome in 1 who underwent a Norwood procedure and double outlet right ventricle with pulmonic stenosis and tricuspid stenosis in 1 who underwent biventricular repair. Among them 10 patients had received other palliative operation before [Norwood procedure 1, pulmonary artery banding 3, modified Blalock-Taussig shunt 6 . The BCPS operations were performed under the cardiopulmonary bypass. 16 patients underwent unilateral BCPS and 17 patients who had bilateral SVC underwent bilateral BCPS. Three patients whose associated anomalies were interruption of IVC underwent total cavopulmonary shunt. There were 5 operative deaths [mortality rate 15.1 % and 2 late deaths. The risk factor for the operation was high mean pulmonary artery pressure [p value<0.05 . The survivors showed good postoperative course and their postoperative oxygen saturation was increased significantly compared to that of preoperative status[p value<0.05 .Conclusively, BCPS operation is effective and safe palliative procedure for the many cyanotic complex congenital anomalies with decreased pulmonary blood flow especialy for the patients who have the high risk factors for Fontan operations.

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References

  1. Surgery of the chest(5th ed.) Sade,R.M.;Fyfe,D.A.;Sabistion,D.C.;Sepencer,F.C.
  2. Circulation v.82 no.SUP. IV The cavopulmonary shunt-evolution of concept Trusler,G.A.;Williams,W.G.;Coren,A.J.
  3. J Thorac Cardiovasc Surg v.88 A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart disease with decreased pulmonary blood flow Nakata,S.;Imai,T.;Takanishi,T.(et al.)
  4. J Thorac Cardiovasc Surg v.87 Total cavopulmonary shunt operation in complex cardiac anomalies Kawashima,T.;Kitamura,S.;Matsuda,H.(et al.)
  5. J Thorac Cardiovasc Surg v.92 Extending the limits for modified Fontan procedure Mayer,J.E.Jr.;Helgason,H.;Jonas,R.A.(et al.)
  6. Circulation v.82 no.SUP. IV Biderectional cavopulmonary anastomosis as interim palliation for high-risk Fontan candiates -early results Bridges,N.D.;Jonas,R.A.;Mayer,J.E.Jr.
  7. Ann Thorac Surg v.47 Bidirectional cavopulmonary shunt : clinical applications as staged or definitive palliation Mazzera,E.;Corno,A.;Picardo,S.
  8. J Thorac Cardiovasc Surg v.90 Physiological rationale for a bidirectional cavopulmonary shunt. A versatile complement to Fontan principle Hopkins,R.A.;Armstrong,B.E.;Serwer,G.A.
  9. Ann Thorac Surg v.31 Glenn shunt. Long-term results and current role in congenital heart operation Pennington,D.G.;Nouri,S.;Ho,J.
  10. J Thorac Cardiovasc Surg v.85 The role of the Glenn shunt in patients undergoing the Fontan operation DeLeon,S.Y.;Idriss,F.S.;Ilbawi,M.N.
  11. Circulation v.72 Abnormal distribution of pulmonary blood flow after the Glenn shunt or Fontan procedure : risk of development of arteriovenous fistula Cloutier,A.;Ash,J.M.;Smallhorn,J.F.(et al.)
  12. Thorax v.27 Tricuspid atresia. Experience in surgical management with a modified cavopulmonary anastomosis Azzolina,G.;Eufrate,S.;Pensa,P.
  13. Circulation v.88 Early bidirectional cavopulmonary shunt in young infants-postoperative course and early results Chang,A.C.;Hamley,F.L.;Gil,W.
  14. J. Pediatr. v.122 Systemic ventricular size and performance before and after bidirectional cavopulmonary anastomosis Berman,N.B.;Kimball,T.R.
  15. 대흉외지 v.25 고식적 목적 혹은 Fontan 수술 전단계로서 시행한 양방향성 상공정맥 폐동맥 단락술의 조기 임상 결과 한재진;나찬영;소동문(등)
  16. Seminars in Thoracic and Cardiovascular Surgery v.6 no.1 Total cavopulmonary operation Kawashima,Y.;Matsuki,O.;Yagihara,T.
  17. J Thorac Cardiovasc Surg v.105 Biventricular repair of hypoplastic right ventricle assisted by pulsatile bidirectional cavopulmonary anastomosis Muster,A.J.;Zales,V.R.;Ilbawi,M.V.(et al.)
  18. Ann Thorac Surg v.55 Cavopulmonary connection in repair of atrioventricular septal defect with small right ventricle Alvarado,O.;Sreeram,N.;McKay,R.;Boyd,I.M.
  19. Seminars in Thoracic and Cardiovascular Surgery v.6 no.1 Staging toward the Fontan operation Giannico,S.;Iorio,F.S.;Carotti,A.;Marcelletti,C.
  20. J Thorac Cardiovasc Surg v.105 Staged Fontan operation for complex cardiac anomalies with subaortic obstruction Di Danato;Amodeo,A.;Di Carlo D. D.