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.

Author: Zumuro Kigajas
Country: Vietnam
Language: English (Spanish)
Genre: Business
Published (Last): 2 January 2016
Pages: 409
PDF File Size: 9.72 Mb
ePub File Size: 3.94 Mb
ISBN: 584-4-70343-565-5
Downloads: 11988
Price: Free* [*Free Regsitration Required]
Uploader: Mikazil

Severity of valve regurgitation can be classified as mild, moderate, or severe. This superior cavopulmonary connection is an intermediate step, both anatomically and physiologically, between initial palliative surgery and the final stage III Fontan repair.

From a surgical perspective, although technically more difficult than the BCPS, the hemi-Fontan operation is reportedly well tolerated and makes a future Fontan procedure bididectional.

The study population was deliberately limited to a selected group of patients i living in France to limit the number of patients who are lost to follow-upii operated upon cavopulmonaty to obtain a minimal follow-up of 10 years and iii treated by the same attending medico-surgical team with the firm intention of delaying Fontan completion as far as possible, despite the fact that the patients were, at the time of BCPS, good candidates for a Fontan pathway.

However, this notion has been disproved in several studies, including an investigation by Lee et al, 45 in which use of enalaprilat in patients with BCPS did not increase the total cardiac output but rather redistributed blood flow to the lower part of the body and decreased pulmonary blood flow and aortic oxygen saturation. The cavopulmohary cavopulmonary Glenn shunt without cardiopulmonary bypass: This nearly always failed with time.

Surgical repair of tricuspid atresia. Effects of cardiac surgery on intellectual function in infants and children. Informed consent was taken for all patients. Survival without definitive repair. Attempt was made to clamp the SVC below the insertion of azygos vein so that it could provide some decompression of the proximal segment until the time the anastomosis was accomplished.


Understanding Stage II Bidirectional Cavopulmonary Shunts

Atrioventricular valve repair in patients with functional single-ventricle physiology: Most data on interstage mortality pertain to infants with hypoplastic bidiirectional heart syndrome and a Norwood operation as the initial surgical palliation. Hazinski M Nieves JA. Once preoperative shujt data are collected, surgeons and cardiologists evaluate candidacy and optimal surgical timing for the individual patient. Outcomes of left atrial isomerism over a year period at a single institution.

Oxford University Press is a department of the University of Oxford.

Excessive pulmonary blood flow, which may overload the ventricle and damage the pulmonary vascular bed, must be avoided. The results were compared with the preoperative examination for evidence of any subtle neurological deficit.

This suggests that delaying Fontan completion as long as possible may not impair the shhunt of this procedure. Unilateral BCPS was performed in 60 patients right cavopukmonary 58, left in 2. They did not utilize any shunt during the clamping of the SVC. They undergo a sequence of operations during the first few years of life that ultimately result in pulmonary blood flow dependent on venous return without a subpulmonary ventricle.

Surgical Experience from bidirrctional Developing Country G. If things were slowing down, you went to the Fontan? In some instances, BCPS has been performed in patients younger than 3 months. No manipulation of the BTS if present was done at this time. They did not report any neurological injury. Patients born with single ventricle physiology have a poor natural prognosis.

The bidirectional cavopulmonary shunt.

The mean transcranial pressure gradient in our patients was BCPS has beneficial effects on both the systemic arterial oxygen saturation by increasing effective pulmonary blood flow and the ventricular function by volume unloading the ventricle [ 5 ].

Cardiopulmonary bypass was used in all patients for a mean time of The BCPS has 2 variations. Bidirectional cavopulmonary ccavopulmonary with additional pulmonary blood flow: Therefore, Fontan circulation imposes caval hypertension particularly in the IVC systemas well as relative pulmonary arterial hypotension in addition to the absence of pulsatility [ 1 ].


Both the BDG and the hemi-Fontan operation provide bidirectional blood flow to the lungs.

I guess my next question relates to if the goal here was to go as far as you could without a Fontan, it is inevitable that if you do a Glenn and a shunt, for example which was a big subgroup in a two-year-old, within a very short period of time, a year or two, three at the outside, that shunt is either going to be gone or completely insignificant.

This conclusion is supported by other recent reports [ 20 ]. Our results show that in selected patients, bidirectional Glenn operation without cardiopulmonary bypass is a bidigectional procedure.

Understanding Stage II Bidirectional Cavopulmonary Shunts

Nearly all failures were related to progressive deterioration in ventricular function, usually associated with AV valve regurgitation only one patient could not undergo Fontan completion because of anatomic factors. Double-inlet ventricle presenting in infancy. Related articles in Google Scholar.

In all Journals Data were described as frequencies, medians with ranges and means with standard deviations, as appropriate. Patients with unstable hemodynamic status after a stage I palliation were repeatedly rehospitalized, had poor weight gain in the interstage phase, and, overall, had worse outcomes than did patients with stable hemodynamic status. Postoperative platelet function is associated with severe bleeding in ticagrelor-treated patients.

Shunts contribute to additional volume loading on the single ventricle by bypassing the lungs and worsening cyanosis.

The bidirectional cavopulmonary Glenn shunt is a commonly performed procedure for bdirectional variety of cyanotic congenital heart diseases that lead eventually to a single ventricle repair. Pressure measurements from catheters placed in femoral veins reflect common atrial filling pressure.