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Bidirectional inferior vena cava-pulmonary artery shunt
1Department of Cardiovascular and Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Paris-Sud University, Paris, France.
The Annals of Thoracic Surgery
|May 1, 1997
Summary
Bidirectional inferior vena cava-pulmonary artery shunt offers a novel approach for univentricular hearts, facilitating complete Fontan circulation. This partial Fontan operation shows promise in selected patients, simplifying subsequent surgical stages.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Bidirectional superior vena cava-pulmonary shunt is a standard palliation for univentricular hearts.
- Bidirectional inferior vena cava-pulmonary artery shunt presents an alternative partial Fontan circulation strategy.
- This approach may simplify subsequent complete Fontan circulation due to an established inferior vena cava lateral tunnel.
Observation:
- The bidirectional inferior vena cava-pulmonary artery shunt was utilized in two patients.
- Contraindications for complete Fontan circulation included a volume-overloaded systemic ventricle and an irregular pulmonary arterial tree.
Findings:
- Both patients experienced uneventful postoperative courses with no significant pleural effusions.
- Transcutaneous oxygen saturation levels were 77% and 78%, with pulmonary-to-systemic blood flow ratios of 0.57 and 0.63.
- Complete Fontan circulation was successfully performed 8 and 12 months post-shunt, free from Fontan-related complications.
Implications:
- Bidirectional inferior vena cava-pulmonary artery shunt may be a valuable option for specific pediatric patients with univentricular hearts.
- Further research is needed to establish its definitive role within partial Fontan operations.
- This technique shows promise for improving outcomes in complex congenital heart disease palliation.