EARLY BIDIRECTIONAL CAVOPULMONARY SHUNT IN YOUNG INFANTS - POSTOPERATIVE COURSE AND EARLY RESULTS

Background. Despite the recent wide applicability of the bidirectional cavopulmonary shunt, there is limited reported experience in performi ng these shunts in infants 6 months or younger. Methods and Results. B efore October 1992, 17 consecutive infants aged 4.2 to 6.5 months (med ian, 6.1 months) underwent bidirectional cavopulmonary shunts. The dia gnoses were hypoplastic left heart syndrome (n=7), single right ventri cle (n=5), and single left ventricle (n=5). All but 2 patients had pri or palliative surgery. The bidirectional cavopulmonary shunt was perfo rmed early on an elective basis in 9 patients; the remaining patients had progressive cyanosis (6 patients), severe ventricular failure (1 p atient), and coexisting restrictive bulboventricular foramen (1 patien t). The median preoperative pulmonary arterial pressure and pulmonary vascular resistance were 15 mm Hg and 2.3 U . m2, respectively. One pa tient died; the overall hospital survival was 94%. The most common pos toperative problem was transient systemic hypertension, observed in 14 (88%) of 16 survivors. Systemic arterial oxygen saturation increased from a median of 75% before surgery to a median of 85% after surgery ( P<.05). The median hospital stay was 6 days. There were no late deaths during follow-up (median, 12.4 months). At postoperative cardiac cath eterization performed in 9 of 16 survivors, there was no evidence of s evere hypoxemia, shunt narrowing, or pulmonary arteriovenous fistulas. Of the 16 survivors, 6 have had a subsequent Fontan operation at a me dian age of 1.9 years; there were 5 survivors. Conclusions. Early bidi rectional cavopulmonary shunt in young infants has shown encouraging e arly results and provides improved oxygenation with low morbidity and mortality. We speculate that an early bidirectional cavopulmonary shun t on an elective basis may reduce the deleterious sequelae of chronic hypoxemia, long-term ventricular volume overload, and repeated palliat ive procedures, thus yielding a more suitable Fontan candidate.