BIDIRECTIONAL INFERIOR VENA-CAVA PULMONARY-ARTERY SHUNT

Background. Bidirectional superior vena cava-pulmonary shunt is widely used as an interim palliation for patients with univentricular hearts . Bidirectional inferior vena cava-pulmonary artery shunt, as an alter native approach of partial Fontan circulation, may offer the advantage of performing the complete Fontan circulation more easily due to the already constructed inferior vena cava lateral tunnel. Methods. We use d bidirectional inferior vena cava-pulmonary artery shunt in 2 patient s. Contraindications to a complete Fontan circulation were due to, res pectively, a volume-overloaded systemic ventricle and an irregular pul monary arterial tree. Results. Postoperative courses were uneventful. There were no significant pleural effusions. Transcutaneous oxygen sat urations were 77% and 78%. Pulmonary-to-systemic blood now ratios were 0.57 and 0.63. A complete Fontan circulation was safely performed 8 a nd 12 months later, without any ''Fontan-related'' complications. Conc lusions. Bidirectional inferior vena cava-pulmonary artery shunt can b e useful in selected patients with univentricular hearts, although its place in the field of ''partial Fontan operations'' cannot be determi ned as yet. (C) 1997 by The Society of Thoracic Surgeons.