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Ann Thorac Surg 1998;66:664-667
© 1998 The Society of Thoracic Surgeons

Supplement

The physiology of the bidirectional cavopulmonary connection

Robert M. Freedom, MDa, David Nykanen, MDa, Lee N. Benson, MDa

a Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto Faculty of Medicine, Toronto, Ontario, Canada

Address reprint requests to Dr Freedom, The Hospital for Sick Children, Rm 1503C, 555 University Ave, Toronto, ON, Canada M5G 1X8

Presented at the Workshop on "One and One-Half Ventricle Repairs," Gubbio, Italy, Dec 6–7, 1996.

Abstract

This article reviews the indications for the bidirectional cavopulmonary connection and demonstrates its efficacy in reducing mortality for the Fontan procedure. The indications for adding an additional source of pulmonary blood flow to the bidirectional cavopulmonary connection are discussed, but this issue remains controversial. Also unclear is whether the bidirectional cavopulmonary connection promotes symmetric growth of the pulmonary arteries, or whether growth of the left pulmonary artery is disadvantaged. Finally, systemic venous collateralization is a well-recognized sequel after cavopulmonary connection. The clinical implications of this collateralization are reviewed.




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