bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. All patients were consid- ered less than “ideal” candidates for a Fontan . The bidirectional cavopulmonary shunt, like the classic. Glenn anastomosis, by virtue of increasing the effective pulmonary flow improves the systemic arterial. Abstract. Objectives: The bidirectional cavopulmonary (Glenn) shunt is a commonly performed procedure for a variety of cyanotic congenital.

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Should the bidirectional Glenn procedure be better performed through the support of cardiopulmonary bypass? Of these, 22 patients had the procedure performed without cardiopulmonary bypass. Compared with older infants, patients undergoing BCPS who are less than 4 months old tend to be more cyanotic immediately after surgery with higher central venous pressure; however this condition tends to normalize during a period of days.

On the other hand, and even if the results should be taken with caution because of the small number of patients, older age at the time of BCPS with APBF was associated with an increased risk of adverse events including postoperative complications, late mortality, need for transplantation and ventricular dysfunction after Fontan completion. In order to maintain an adequate cerebral flow by maintaining a higher transcranial pressure gradient, we electively used dopamine and loaded the patients with plenty of volume.

The hybrid stage I procedure is often considered a less complicated procedure in the neonatal period compared with a Norwood operation and does not require cardiopulmonary bypass. Circulatory bypass of the right side of the heart.

Understanding Stage II Bidirectional Cavopulmonary Shunts

Excessive pulmonary blood flow, which may overload the ventricle and damage the pulmonary vascular bed, must be avoided. Ages and weights at operation averaged 5. This reverse mBTS augments aortic blood cwvopulmonary should retrograde caovpulmonary obstruction occur, thus preserving flow to the coronary arteries and head. The post-procedure complications are shown in table 3. Such a qualitative assessment provides a composite picture of a child’s developmental age, and his or her integrity in the total growth process.


Close mobile search navigation Article navigation. When ventricular function was very good, we tended to place another shunt. Four patients had bilateral Glenn procedure done and one had additional right pulmonary artery-plasty done. There are some preliminary answers to this question.

Understanding Stage II Bidirectional Cavopulmonary Shunts

Mortality has declined with the advent of focused interstage monitoring. This confirms the results noted in other series in which patients were systematically entered in a staging to Fontan policy [ 15—17 ].

The strategy also may be used as a salvage option for especially small babies until a definitive decision is made for optimal repair or palliation. Predictors of rhythm disturbances and subsequent morbidity after the Fontan operation.

Previous placement of pulmonary artery bands may cause the proximal pulmonary arteries to become narrowed and bidirecttional, necessitating reconstruction of the branch pulmonary artery during the BCPS surgery. Echocardiography is used to evaluate ventricular function, AVV morphology and regurgitation, outflow tract and semilunar valve function. We observed that during the same clamp period there was a gradual decrease in the central venous pressure without much difference in the systemic arterial pressure.

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The bidirectional cavopulmonary shunt.

TE was chosen as tool to assess ventricular function, anatomical defects for diagnosisvalve status, and pericardial effusion. I guess I have then, just one more comment. Functional outcome, including evolution of ventricular function, was evaluated as well. Primary end-points included survival, need for heart transplantation HTxneed for Fontan completion and suitability for Fontan completion.


Informed consent was taken for all patients. Particular risk factors for poor outcomes within heterotaxy syndromes or isomerism are total anomalous pulmonary venous drainage, atrioventricular abnormalities, pulmonary atresia, and arrhythmias, including heart block.

In patients with single ventricle physiology, Fontan circulation is considered as the optimal surgical approach, although it entails a growing incidence of late complications. More on this topic Staged surgical repair of functional single ventricle in infants with unobstructed pulmonary blood flow.

The bidirectional cavopulmonary shunt.

Home surveillance program prevents interstage mortality after the Norwood procedure. This was a selected group of patients with good ventricular function who were supposed to become good candidates for a Fontan.

The BDG procedure can be done with or without cardiopulmonary bypass, whereas xhunt hemi-Fontan operation is always performed with cardiopulmonary bypass. The clinical profile is given in Table 1. Earlier surgery may be necessary if evidence indicates progressive hypoxemia due to shunt instability or pulmonary artery stenosis.

An alternative to the total cavo-pulmonary circulation in patients with a functionally single ventricle.