USEFULNESS OF PULSATILE BIDIRECTIONAL CAVOPULMONARY SHUNT IN HIGH-RISK FONTAN PATIENTS

Background. A bidirectional cavopulmonary shunt has been performed for the high-risk Fontan patient. It is well known that in the presence o f the bidirectional cavopulmonary shunt alone to secure pulmonary bloo d flow, the central pulmonary artery size decreases over time. We have performed pulsatile bidirectional cavopulmonary shunt (PBCPS), keepin g pulmonary blood now from the ventricle through the stenotic pulmonar y valve, or a Blalock-Taussig shunt in patients who do not meet the cr iteria for the Fontan operation. Methods. Eleven patients who underwen t PBCPS between 1989 and 1993 were reviewed. We compared the results o f cardiac catheterization immediately before PBCPS and during the post operative observation period (310 +/- 257 days). Results. Pulmonary bl ood flow and arterial oxygen saturation increased significantly after PBCPS (p < 0.01). Pulmonary artery area index showed a tendency to inc rease (p = 0.11). The mean number of risk factors for the Fontan proce dure decreased significantly from 1.8 +/- 1.1 to 0.7 +/- 0.8 after PBC PS (p < 0.05). Overall, 5 of the 11 patients (45.5%) met the criteria for the Fontan procedure, and a fenestrated Fontan procedure was carri ed out in 4 of them. Conclusions. The PBCPS is useful for high-risk Fo ntan patients not only in the staged Fontan operation, but also as def initive palliation.