NEW APPROACH IN PARTIAL CAVOPULMONARY CONNECTION

The development of pulmonary arteriovenous fistulas after bidirectiona l cavopulmonary operations, such as the bidirectional Glenn shunt and Kawashima's procedure, has raised concern. Development of these fistul as, which are more frequent than initially thought, can represent a li miting factor in the late outcome of these patients and may even limit the indication for these types of surgery. Whether the fistulas can b e reversed by transforming the surgical procedures has yet to be estab lished. In the hope of avoiding this kind of complication, thought to be caused by the lack of passage of a hypothetical hepatic factor thro ugh the pulmonary circulation, eve have developed an inverted type of bidirectional cavopulmonary connection in which the blood coming from the liver perfuses immediately both lungs. This is made possible by sh unting via an intra-atrial tunnel the blood from the superior caval ve in directly to the left atrium, and the blood from the inferior caval vein to the right branch of the pulmonary trunk (keeping its bifurcati on intact). We describe findings in two patients undergoing successful surgery with this technique. Serial follow-up with contrast echocardi ography did not show evidence of arteriovenous pulmonary fistulas. Des pite our numbers being small, and the time of follow-up being limited, we believe that it is important to document these and similar cases.