[Bidirectional cava-pulmonary anastomosis in complex congenital heart defects]

An operation for bidirectional cava-pulmonary anastomosis was performed in 11 patients. Anatomical correction could not be made due to the multiple pattern and complexity of the malformation. None of them was, however, an ideal candidate for hemodynamic correction either. The authors took into account not only anatomical and hemodynamic contraindications for Fontana's operation, but the latter was not performed when the patient's status was grave (severe hypoxemia). The operation was made under extracorporeal circulation and hypothermia. In addition to bidirectional cava-pulmonary anastomosis, dilation of the intraatrial junction, pulmonary artery plasty, etc. were conducted in some cases. Bilateral bidirectional cava-pulmonary anastomosis was performed when an accessory vena cava superior was present. Nine patients benefited from the operation. There was a significant health improvement and a substantial increase in arterial blood oxygen saturation. Four patients underwent a repeated examination one year after surgery. The anastomosis was found to function well.