Bidirectional Cavopulmonary Shunt with Additional Pulmonary Blood Flow

There are some controversies regarding the usefulness of leaving additional pulmonary blood flow when establishing a bidirectional cavopulmonary shunt. From April 2002 to September 2008, 13 patients (mean age, 24 +/- 16 months) underwent a bidirectional cavopulmonary shunt procedure with fine adjustment of additional pulmonary blood flow, as an intermediate step before the Fontan operation. There were no hospital deaths. Modified Blalock-Taussig shunts were left during the bidirectional cavopulmonary shunt operation in 7 patients, and pulmonary bands were tightened in 4. The main pulmonary artery with a previous pulmonary band was left open in one case. Oxygen saturation increased from 74.5% +/- 7.4% to 84.6% +/- 1.9% after the operation, cardiothoracic ratio decreased from 55.9% +/- 6.1% to 53.2% +/- 3.4%, Left ventricular end-diastolic pressure decreased from 11.0 +/- 2.6 to 7.8 +/- 3.0 mm Hg, and mean pulmonary arterial pressure from 14.7 +/- 7.5 to 10.2 +/- 3.1 mm Hg. Pulmonary artery index did not change significantly. In our experience, additional pulmonary blood flow with adjustment in each patient at the time of shunt construction was an excellent temporary palliation prior to the Fontan operation.