McElhinney D B, Reddy V M, Moore P, Hanley F L
Division of Cardiothoracic Surgery, University of California, San Francisco, 94143-0118, USA.
Ann Thorac Surg. 1997 Jun;63(6):1676-84. doi: 10.1016/s0003-4975(97)00364-0.
Bidirectional cavopulmonary shunt and Fontan repair are now commonly performed in patients with a variety of forms of complex single ventricle, including those with anomalies of systemic or pulmonary venous return. These anomalies are ideally dealt with during bidirectional cavopulmonary shunt, thereby minimizing the complexity of the eventual Fontan procedure.
Between March 1990 and December 1995, 36 patients with anomalous systemic or pulmonary venous drainage underwent bidirectional cavopulmonary shunt. A combination of anomalous systemic and pulmonary venous drainage was present in 12 patients, whereas 19 patients had anomalous drainage only from the systemic circulation and 5 patients had isolated anomalies of pulmonary venous return. Visceral heterotaxy syndrome was diagnosed in 18 patients. The median age at operation was 11 months, and bidirectional cavopulmonary shunt was the first surgical procedure performed in 10 of these patients. Techniques of repair are described.
There were two early deaths and one bidirectional cavopulmonary shunt was taken down, for mortality and failure rates not significantly different than those for all patients undergoing bidirectional cavopulmonary shunt during this time period (n = 117). At a mean follow-up of 19.9 months, there have been three late deaths and 11 patients have undergone Fontan completion. Actuarial survival was 87% at 1 year and 81% at 3 years. Among all patients undergoing bidirectional cavopulmonary shunt during this time period, neither heterotaxy syndrome nor anomalies of systemic or pulmonary venous return were significantly associated with decreased survival or poor outcome.
Bidirectional cavopulmonary shunt can be performed in patients with anomalous systemic or pulmonary venous drainage, including those with visceral heterotaxy syndrome, with morbidity and mortality rates that do not differ significantly from those achieved in all patients undergoing bidirectional cavopulmonary shunt. In this report, we describe our experience with this group of patients, primarily focusing on outcomes and technical issues that pertain to the use of bidirectional cavopulmonary shunt as a preparatory procedure for the extracardiac conduit Fontan operation.
双向腔肺分流术和Fontan修复术目前常用于患有各种复杂单心室形式的患者，包括那些存在体循环或肺静脉回流异常的患者。这些异常情况理想情况下应在双向腔肺分流术期间进行处理，从而将最终Fontan手术的复杂性降至最低。
1990年3月至1995年12月期间，36例体循环或肺静脉引流异常的患者接受了双向腔肺分流术。12例患者同时存在体循环和肺静脉引流异常，19例患者仅存在体循环引流异常，5例患者存在孤立的肺静脉回流异常。18例患者被诊断为内脏异位综合征。手术时的中位年龄为11个月，其中10例患者的双向腔肺分流术是首次进行的外科手术。描述了修复技术。
有2例早期死亡，1例双向腔肺分流术被拆除，死亡率和失败率与同期接受双向腔肺分流术的所有患者（n = 117）相比无显著差异。平均随访19.9个月时，有3例晚期死亡，11例患者已完成Fontan手术。1年时的精算生存率为87%，3年时为
