[Total cavopulmonary shunts. Short- and mid-term results apropos of 19 cases]

Experimental and clinical studies show that total cavopulmonary shunt operations may prevent certain complications of the Fontan atriopulmonary procedure. The authors have used the total cavopulmonary shunt instead of the Fontan procedure since February 1990. Nineteen consecutive patients were operated by three different surgical teams; 18 patients had undergone prior palliative surgery. The shunt was carried out by Puga's modified Kreutzer technique or by the construction of an extracardiac autologous pediculated pericardial tube. There were two deaths (10.5%) attributed to severe stenosis of the left pulmonary artery. The postoperative course was complicated in most of the 17 survivors but after a follow-up of 3 to 57 months (average 24.9 +/- 13.6 months) all were in the NYHA functional classes I (N = 15) or II (N = 2) with an arterial saturation over 85% in 15/17 cases and a cardiothoracic index less than 53% in 14/17 cases. All were in sinus rhythm. Doppler echocardiography showed no obstruction of the bypass. Pulmonary flow in 11 cases had a venous morphology. The function of the single ventricle was slightly depressed in 3 cases (2 of which were operated late, at 16 years of age). Catheterisation and cavography in 13 children showed uniform pressures in the cavopulmonary connection with no pressure gradient, except in 1 child. A right atrial'a'wave transmitted to the pulmonary arteries and inferior vena cava accompanied by retrograde vena cava flow was observed in 4 of the 6 cases with a Puga or modified Kreutzer procedure. Fenestration of the connection was closed by a Sideris button device in one case; reoperation was required in another.(ABSTRACT TRUNCATED AT 250 WORDS)