Document Detail


Early bidirectional cavopulmonary shunt in young infants. Postoperative course and early results.
MedLine Citation:
PMID:  7693365     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite the recent wide applicability of the bidirectional cavopulmonary shunt, there is limited reported experience in performing these shunts in infants 6 months or younger. METHODS AND RESULTS: Before October 1992, 17 consecutive infants aged 4.2 to 6.5 months (median, 6.1 months) underwent bidirectional cavopulmonary shunts. The diagnoses were hypoplastic left heart syndrome (n = 7), single right ventricle (n = 5), and single left ventricle (n = 5). All but 2 patients had prior palliative surgery. The bidirectional cavopulmonary shunt was performed early on an elective basis in 9 patients; the remaining patients had progressive cyanosis (6 patients), severe ventricular failure (1 patient), and coexisting restrictive bulboventricular foramen (1 patient). The median preoperative pulmonary arterial pressure and pulmonary vascular resistance were 15 mm Hg and 2.3 U.m2, respectively. One patient died; the overall hospital survival was 94%. The most common postoperative problem was transient systemic hypertension, observed in 14 (88%) of 16 survivors. Systemic arterial oxygen saturation increased from a median of 75% before surgery to a median of 85% after surgery (P < .05). The median hospital stay was 6 days. There were no late deaths during follow-up (median, 12.4 months). At postoperative cardiac catheterization performed in 9 of 16 survivors, there was no evidence of severe hypoxemia, shunt narrowing, or pulmonary arteriovenous fistulas. Of the 16 survivors, 6 have had a subsequent Fontan operation at a median age of 1.9 years; there were 5 survivors. CONCLUSIONS: Early bidirectional cavopulmonary shunt in young infants has shown encouraging early results and provides improved oxygenation with low morbidity and mortality. We speculate that an early bidirectional cavopulmonary shunt on an elective basis may reduce the deleterious sequelae of chronic hypoxemia, long-term ventricular volume overload, and repeated palliative procedures, thus yielding a more suitable Fontan candidate.
Authors:
A C Chang; F L Hanley; G Wernovsky; H M Rosenfeld; D L Wessel; R A Jonas; J E Mayer; J E Lock; A R Castaneda
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  88     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1993 Nov 
Date Detail:
Created Date:  1993-11-29     Completed Date:  1993-11-29     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  II149-58     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Children's Hospital, Boston, MA 02115.
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MeSH Terms
Descriptor/Qualifier:
Arteriovenous Shunt, Surgical / methods*
Follow-Up Studies
Heart Catheterization
Heart Defects, Congenital / epidemiology,  surgery*
Humans
Hypertension / epidemiology
Infant
Palliative Care / methods*
Postoperative Complications / epidemiology
Pulmonary Artery / surgery*
Retrospective Studies
Time Factors
Vena Cava, Superior / surgery*
Grant Support
ID/Acronym/Agency:
HL-41786/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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