BIDIRECTIONAL CAVOPULMONARY SHUNT WITH AN ADDITIONAL SOURCE OF PULMONARY FLOW - AN INTERIM OR FINAL STAGE OF PALLIATION

A bidirectional cavopulmonary shunt is performed in patients with sing le ventricle physiology to improve or maintain systemic oxygenation wh ile decreasing the workload of the heart. During a period of 10 years, bidirectional cavopulmonary shunts were performed in 50 patients at o ur institution. The procedure was performed with an additional source of pulmonary flow through the pulmonary valve or a systemic to pulmona ry shunt in 27 patients and without an additional source of pulmonary flow in 23 patients. Preoperative and postoperative chest radiographs, pulmonary angiograms, oxygenation, hemodynamic measurements, morbidit y, and mortality were reviewed to determine whether a bidirectional ca vopulmonary shunt with an additional source of pulmonary flow is an ac ceptable interim or final stage of palliation. Systemic oxygenation wa s improved only in patients with an additional source of pulmonary flo w. The outcome of the bidirectional cavopulmonary shunt was not advers ely affected by the presence of additional pulmonary flow Twenty-five patients subsequently underwent an atrial to pulmonary or total cavopu lmonary anastomosis. Oxygenation was improved by more definitive palli ation; however, late complications of stroke, protein losing enteropat hy, and arrhythmias requiring pacemaker therapy were more prevalent. I n conclusion, systemic oxygenation can be improved by performing the b idirectional cavopulmonary shunt with an additional source of pulmonar y flow through the pulmonary valve or a systemic to pulmonary shunt wi thout an adverse effect on hemodynamic measurements, pulmonary arteria l growth, morbidity, or survival. The bidirectional cavopulmonary shun t may be an acceptable final stage of palliation in some patients with a functionally single ventricle.