bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. All patients were consid- ered less than “ideal” candidates for a Fontan . The bidirectional cavopulmonary shunt, like the classic. Glenn anastomosis, by virtue of increasing the effective pulmonary flow improves the systemic arterial. Abstract. Objectives: The bidirectional cavopulmonary (Glenn) shunt is a commonly performed procedure for a variety of cyanotic congenital.

Author: Goltihn Vogami
Country: Dominica
Language: English (Spanish)
Genre: Career
Published (Last): 10 May 2004
Pages: 142
PDF File Size: 2.70 Mb
ePub File Size: 19.15 Mb
ISBN: 898-7-58321-653-3
Downloads: 42507
Price: Free* [*Free Regsitration Required]
Uploader: Visida

Efficacy and safety of transvenous lead extraction in consecutive patients: The role of the Glenn shunt in patients undergoing the Fontan operation. The mean SVC clamp time was This nearly always failed with time. Fontan operation in patients with tricuspid atresia: You can also find us on social media: We conducted the operation with the head-end of the operating table elevated so that the venous drainage would find alternative pathways and the proximal caval pressure be kept as low as possible.

Postoperative platelet function is associated with severe bleeding in ticagrelor-treated patients. Impact of 3-mm Blalock—Taussig shunt in neonates and infants with a functionally single ventricle.

Understanding Stage II Bidirectional Cavopulmonary Shunts

At a mean follow-up of This resulted in increased central venous pressure, reduced cerebral blood flow velocities, followed by regional cerebral venous oxygen desaturation and global electroencephalographic slowing. Younger patients had longer ICU length of stay, duration of mechanical ventilation, and hospital length of stay but did not differ from older patients in room air oxygen saturations at the time of discharge, mortality, and length of time to the Fontan procedure.

There are several technical advantages to cavopulmonary shunt when compared with other Fontan modifications. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics. Cardiopulmonary bypass was used in all patients with mean time of A univariate analysis indicated that hospital death after BCPS was associated with moderate or greater AVV regurgitation and higher right ventricular end-diastolic pressure before BCPS catheterization.


So the next important question is why did you put an extra source in some patients and not in others, because that is very important if we try to generalize these conclusions, because we now have a very selected group of patients. Hazinski M Nieves JA.

Six patients underwent HTx one after Fontan completion with two early deaths and no late mortality. But your study found the exact opposite. When ventricular function was very good, we tended to place another shunt.

This was done using inotropic agents whenever required. The decision to conduct the procedure without CPB was made after complete evaluation with echocardiography and cardiac catheterization.

In patients with single ventricle physiology, the surgical protocol adopted in most centres follows a staging approach and includes BCPS and later Fontan completion.

Mosby Elsevier ; In those who did not have a previous BTS, perfusion to only the lung opposite to the side of Glenn anastomosis was maintained during the procedure. Patients with successful repair and preserved ventricular function have had the best survival.

The bidirectional cavopulmonary shunt.

Maintaining a mild respiratory acidosis with a carbon dioxide level of 45 to 55 mm Hg is effective in increasing xhunt blood flow without markedly elevating pulmonary vascular resistance.

Echocardiography is also used to evaluate the atrial septum, systemic and pulmonary veins, the aortic arch, branch pulmonary arteries, and residual shunts.

No drainage techniques were used to decompress the proximal SVC. Of these, 22 patients had the procedure performed without CPB. Median age at Fontan completion was 9 years range: All patients were ventilated with mean of 1. The developmental quotient DQ or IQ score was calculated in each patient. Preoperative evaluations including cardiac catheterization procedures are used to assess the cavopulmonarh of narrowing and anatomic distortion.


In addition, at the time of the modified Fontan operation, the cavopulmonary shunt approach may optimize the anatomic connection eight additional patients. Regardless of previous surgery, in all types of stage II operations, the BCPS is created by dividing the SVC above the right atrium cavpulmonary anastomosing the SVC to the pulmonary artery, allowing for bidirectional or right and left flow of deoxygenated blood from the head and arms to the lungs, bypassing the heart.

Bidirectiobal comparison of different transient external shunt techniques in bidirectional cavo-pulmonary shunt. Having a solid knowledge of the complexities of this congenital cardiac defect gives nurses a unique opportunity to optimize outcomes.

Median age cavopulmojary operation was 2 years range: Recognizing warning signs of complications, communicating concerns early, and managing problems effectively are essential for optimizing outcomes for BCPS patients see Table. The very late results of Fontan circulation may be disappointing [ 2 ].

Understanding Stage II Bidirectional Cavopulmonary Shunts

Such a qualitative assessment provides a composite picture of a child’s developmental age, and his or her integrity in the total growth process. None of the patients had any hemodynamic compromise or significant decrease in systemic oxygen saturation on clamping the SVC Table cavopulmonarj.

So that was the thinking behind it. Although the information is scarce, these data suggest that adding some pulmonary blood flow to BCPS may not impair survival and the rate of suitability for Fontan [ 1213 ].