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Ann Thorac Surg 1996;61:849-850
© 1996 The Society of Thoracic Surgeons

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Invited Commentary

Invited Commentary

Department of Cardiovascular Surgery Boston Children's Hospital 300 Longwood Ave Boston, MA 02115

The first 20% of the full text of this article appears below.

See also page 845.

This article by Miyaji and co-workers in which a pulsatile bidirectional cavopulmonary shunt (BCPS) operation is advocated raises important conceptual questions regarding the management of patients with functional single ventricle. These issues include (1) the effects of chronic volume loading on the function of a single ventricle and atrioventricular valve, (2) the effect of pulsatile versus nonpulsatile blood flow on central pulmonary artery growth and on pulmonary arteriolar resistance, (3) and the aggregate effects of the first two issues on the suitability of a given patient for a Fontan-type operation.

Intuitively, I have always thought that chronic volume loading of a single ventricle, as occurs when pulmonary blood flow is provided by the single ventricle (either pulmonary stenosis [native or pulmonary artery band] or a systemic-to-pulmonary artery shunt) will be detrimental to the function of that single ventricle. One of the benefits of the ``nonpulsatile'' BCPS is that it allows these systemic-to-pulmonary artery connections (which provide the ventricular volume load) to be eliminated. Therefore, when such connections are . . . [Full Text of this Article]

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Usefulness of Pulsatile Bidirectional Cavopulmonary Shunt in High-Risk Fontan Patients

Kagami Miyaji, Munehiro Shimada, Akihiko Sekiguchi, Akira Ishizawa, and Takayoshi Isoda
Ann. Thorac. Surg. 1996 61: 845-850. [Abstract] [Full Text]

This article has been cited by other articles:

				R. D. Mainwaring and J. J. Lamberti Usefulness of pulsatile bidirectional cavopulmonary shunt in high-risk Fontan patients Ann. Thorac. Surg., December 1, 2003; 76(6): 2167 - 2167. [Full Text] [PDF]