[Cavo-bipulmonary anastomosis. Apropos of 3 cases].

Cavo-bipulmonary anastomosis (CBPA) in an anastomosis between the superior vena cava and the right pulmonary artery in continuity with the left pulmonary artery. This shunt is used in complex cyanotic congenital heart disease with pulmonary stenosis. It is the first stage of a total cavo-pulmonary shunt (TCPS). Thirty patients underwent this procedure at Laënnec Hospital between April 1988 and April 1990. The surgical indications were retained when TCPS appeared to be too risky, mainly because of the associated malformations, the correction of which was performed at the same time. There were to early deaths; one patient was lost to follow-up and 27 patients have been followed up for an average period of 12 +/- 6 months. The surgical result was judged according to the degree of cyanosis; a poor result was defined as systemic saturation of less than 75% and a haematocrit of over 55%. One child died 5 months after surgery; there were 16 good results and 10 poor results. Seven patients were reoperated to carry out the second stage of the TCPS. The average gain in saturation was 9.7% in our series. Analysis of the patients who died or who had poor surgical results showed an anatomic cause in 11 of the 13 cases (pulmonary arteriovenous fistula, stenosis of the branches of the pulmonary artery, regurgitation of an atrioventricular valve) or a physiopathological cause (mean pulmonary artery pressure greater than 20 mmHg, or ventricular failure). The CBPA is a palliative procedure to reduce ventricular load, repair stenosis of the right pulmonary artery and to prepare the patient for a total cavopulmonary shunt.