Objective: The importance of bidirectional cavopulmonary anastomosis for palliation of complex cyanotic con-genital heart disease is widely recognized. This study was conducted to highlight our surgical experience withthis procedure in a developing country.
Methods: A retrospective study was conducted using medical records at the Aga Khan University Hospital,Karachi, Pakistan. Clinical findings at presentation, anatomical defects seen on transthoracic echocardiography,pre-operative McGoon index, cardiopulmonary bypass time, use of cardioplegia,post-procedure oxygen satura-tions and complications were evaluated.
Results: A total of 8 patients underwent bidirectional cavopulmonary anastomosis. There were 6 males (75%)and 2 females (25%). Ages and weights atoperation averaged 5.7 ± 3.7 years (range 2-14 years) and 18.6 ±10.4 kg (range 8.5-35.5 kg) respectively. The most common symptoms were the presence of cyanosis in all(100%) patients followed by recurrent respiratory tract infections in 3 (37.5%) patients. Transthoracic echocar-diography revealed 6 (75%) patients with atrial septal defects, 5 (62.5%) with tricuspid atresia, 3 (37.5%) with ventricular septal defects, 3 (37.5%) with malposition of great vessels, 2 (25%) with pulmonary stenosis and 2(25%) with double inlet left ventricles. The mean pre-procedure McGoon index was 2.1 ± 0.5 (range 1.37-2.80).All patients received cardioplegia. Cardiopulmonary bypass was used in all patients for a mean time of 154.1 ± 83.6 minutes (range 60-298 minutes). All patients were ventilated for a mean period of 1.5 ± 0.7 days (range 1-3 days). The ICU stay was 3.0 ± 0.6 days (range 2-5 days) with a total hospital stay of 9.8 ± 3.8 days (range 7-18 days). The mean post-procedure oxygen saturation was 82.6 ± 3.5% (range 76-86%). The most commonpost-operative complication was supraventricular arrhythmia in 2 (25.0%) patients. There were no intra-opera- tive or early (within 7 days of procedure) deaths. One patient developed pulmonary artery hypertension and died 23 months later due to cardiac arrest.
Conclusion: Patients tolerated the procedure well. After a mean follow-up of 10 months, 6 patients were assessed to be in New York Heart Association (NYHA) functional class I and one patient in NYHA class II.Clinical and post-procedural data gathered from our experience confirms the safety of bidirectional cavopul-monary anastomosis
Journal of Pakistan Medical Association
(2003). Bidirectional cavopulmonary shunt for cyanotic heart disease: surgical experience from a developing country. Journal of Pakistan Medical Association, 53(10), 506-508.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_cardiothoracic/87