From March 1990 to January 1994, 17 patients 1 to 13 years old (mean 7 years), who had congenital heart disease with functional isolated ventricular chamber, were submitted to bidirectional cavopulmonary shunts. Nine cases had Tricuspid Atresia (TA) (7 type Ib, 1 type Ic and 1 type IIb). Five cases had Double Inlet Right ventricle (Dl RV); two cases had multiple Ventricular Septal Defects (VSD) plus RV hypoplasia. One case had pulmonary atresia with Intact Ventricular septum (PA/IVS). Nine (52,9%) patients had been submitted, to previous paliative operations. The operations in 12 (70,5%) cases were with extracorporeal circulation (ECC) and in 5 (29,4%) cases with superior vena cava (SVC) to right atrio (RA) temporary shunt. In all cases the SVC was anastomosed to right pulmonary artery (RPA) closing the pulmonary valve (PV) or linking the Blalock-Taussig shunt to interrupt the pulmonary flow. There are three (17,6%) deaths in the immediate postoperative period and 2 (14,2%) late deaths. Twelve (70,5%) patients were followed-up for 2 to 46 months. One patient was submitted to the 2 nd operation, tunnelating the inferior vena cava (IVC) to RPA, with success. The assessment of bidirectional cavopulmonary flow was made with Doppler echocardiography and magnetic resonance and the pulmonary perfusion was made with radioisotopic cintilography. The indication tor the 2 nd, operation depended on the clinical evolution and assessment of arterial saturation during the cicloergometric test. The bidirectional cavo pulmonary shunt allows the progressive adaptation of the venous flow to lung and reduced ventricular volume load, preparing the patient to total venous shunt.
cavopulmonary shunt