The Cavopulmonary Anastomosis: Evolution of a Palliative Technique

An anastomosis between the superior vena cava and the right pulmonary artery was devised to increase pulmonary blood flow in congenital heart malformations characterized by pulmonary hypoperfusion. The problem of oxygenation of the pulmonary blood under venous pressure and without the contribution of the right cardiac output was first studied and applied experimentally by Carlon, Mondini, and De Marchi, at the University of Padova, by creating a connection between the superior vena cava and the right pulmonary artery. This operation has been replicated both experimentally and clinically by many others but the original Italian contribution has been neglected for many years. The cavopulmonary anastomosis to the right pulmonary artery, as initially designed, has essentially been abandoned and replaced by the bidirectional cavopulmonary anastomosis. Nevertheless, the ingenuity of those who first devised it must be adequately appreciated, respected, and remembered.