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Ann Thorac Surg 2002;74:971-972
© 2002 The Society of Thoracic Surgeons
a Department of Cardiovascular Surgery Pediatric Cardiology, National Children’s Hospital, Tokyo, Japan
b Department of Pediatric Cardiology, National Children’s Hospital, Tokyo, Japan
* Address reprint requests to Dr Chikada, Division of Cardiovascular Surgery, National Center for Child Health and Development, 2-10-1 Ookura Setagaya-ku, Tokyo 157-8535, Japan
e-mail: chikada-m{at}ncchd.go.jp
The staged Fontan operation was usually performed in patients who did not meet the criteria for the Fontan procedure. At the time of bidirectional cavopulmonary shunt, there is controversy as to whether additional flow to the pulmonary artery is left open or not [1, 2].
Recently Kurotobi and colleagues [3] suggested that the pulsatility of pulmonary flow was important to keep endothelial function after bidirectional cavopulmonary shunt. Only a few articles reported the long-term effect of additional flow to the pulmonary artery after bidirectional cavopulmonary shunt [4].
Six years ago we reported 11 patients who underwent pulsatile bidirectional cavopulmonary shunt (PBCPS), keeping pulmonary blood flow from the ventricle through the stenotic pulmonary valve, or a Blalock-Taussig shunt [5]. Those patients did not meet the criteria for the Fontan operation. Four of 10 patients, who were alive after PBCPS, underwent the fenestrated Fontan operation. The period from PBCPS to the fenestrated Fontan operation ranged from 1.5 to 2 years. We followed 6 patients who did not undergo the Fontan operation at that time. Postoperative risk factors in 6 patients for the Fontan operation were high pulmonary vascular resistance in 3 patients, low pulmonary area index in 2, and poor ventricular ejection fraction in 1. The follow-up period after PBCPS ranged from 11/2 to 11 years (median, 9 years). After PBCPS, the Fontan operation has not been completed in any patients. Two patients died during follow-up. One patient with poor ventricular ejection fraction died of congestive heart failure 11/2 years after PBCPS. Another patient with high pulmonary vascular resistance died of severe cyanosis 8 years after the operation. The takedown of bidirectional cavopulmonary shunt was performed in 1 patient because of progress of cyanosis 9 years after PBCPS. The arterial oxygen saturation increased from 65% to 80% after takedown. Overall, 4 patients are alive after PBCPS without the completion of the Fontan procedure. Arterial oxygen saturations in those patients are 70% to 74% and pulmonary area indexes ranged from 120 to 200 mm2/m2. The result of the additional flow to the pulmonary artery was not effective long-term.
In conclusion, the results of PBCPSs in high-risk Fontan candidates could be useful in the short-term. However, the long-term result of PBCPS was not effective to complete the subsequent Fontan procedure and could not improve arterial oxygen saturation or pulmonary area index.
Footnotes
References
This article has been cited by other articles:
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  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]
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M. Chikada and A. Sekiguchi Usefulness of pulsatile bidirectional cavopulmonary shunt in high-risk Fontan patients: Reply Ann. Thorac. Surg., December 1, 2003; 76(6): 2167 - 2167. [Full Text] [PDF]
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