ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
THE EARLY RESULTS OF BIDIRECTIONAL CAVO-PULMONARY ANASTOMOSIS PERFORMED BY USING EXTERNAL SHUNTS IN PATIENTS WITH SINGLE VENTRICLE PHYSIOLOG
Yusuf KALKO, Faruk HÖKENEK, Vural ÖZCAN, Murat BAŞARAN, Emin TİRELİ, Ufuk ALPAGUT, Enver DAYIOĞLU, Ertan ONURSAL
İstanbul Üniversitesi İstanbul Tıp Fakültesi, Kalp Damar Cerrahisi Ana Bilim Dalı, İstanbul
Background: Bidirectional cavopulmonary shunt has become an increasingly applied procedure in patients with single ventricle physiology. The aviodance of cardiopulmonary bypass during the construction of anastomosis decreases the necessity of inotropic support, the duration of mechanical ventilation and the incidence of pleural effusions.

Methods: In our institution, 17 patients with ages ranging from 6 to 36 months possessing single ventricle physiology underwent bidirectional cavopulmonary anastomosis. Their weight ranged from 5 to 13.5 kg. The operations were performed by using a transient shunt between the superior vena cava and right atrium. The diagnosis was tricuspid atresia in 11 patients (64%), transposition of the great arteries + ventricular septal defect + pulmonary stenosis in 2 (12%), transposition of the great arteries + ventricular septal defect in 2 (12%), double outlet right ventricle + pulmonary stenosis in 1 (6%), and Uhl’s anomaly in 1 (6%). Bilateral cavopulmonary anastomosis was constructed in 4 patients who had bilateral superior vena cava. All of the patients tolerated the procedure well without any hemodynamic compromise.

Results: There were 2 early deaths. The remaining patients were extubated within 6 hours. The intensive care unit stay length ranged from 1 to 3 days. Postrepair mean arterial oxygen saturation was 91.8% (87-95%). Pulmonary arterial pressure ranged from 13 mmHg to 18 mmHg.

Conclusions: Bidirectional cavopulmonary anastomosis can be performed effectively by using a transient shunt between the superior vena cava and the right atrium. This procedure can be operated succesfully as stage operation in Fontan circulation. Also the usage of temporary external shunt can achieve success rate.

Keywords : Single ventricle, external shunt, bidirectional cavopulmonary anastomosis
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