PMID- 14696898
OWN - NLM
STAT- MEDLINE
DCOM- 20040213
LR  - 20080212
IS  - 0030-9982 (Print)
IS  - 0030-9982 (Linking)
VI  - 53
IP  - 10
DP  - 2003 Oct
TI  - Bidirectional cavopulmonary shunt for cyanotic heart disease: surgical experience 
      from a developing country.
PG  - 506-9
AB  - OBJECTIVE: The importance of bidirectional cavopulmonary anastomosis for 
      palliation of complex cyanotic congenital heart disease is widely recognized. 
      This study was conducted to highlight our surgical experience with this 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 saturations 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 at operation 
      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 echocardiography 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 common post-operative complication was 
      supraventricular arrhythmia in 2 (25.0%) patients. There were no intra-operative 
      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 cavopulmonary 
      anastomosis.
FAU - Khan, G
AU  - Khan G
AD  - Department of Cardiothoracic Surgery, The Aga Khan University, Karachi.
FAU - Ali, S S
AU  - Ali SS
FAU - Fatimi, S H
AU  - Fatimi SH
LA  - eng
PT  - Journal Article
PL  - Pakistan
TA  - J Pak Med Assoc
JT  - JPMA. The Journal of the Pakistan Medical Association
JID - 7501162
SB  - IM
MH  - Adolescent
MH  - Arrhythmias, Cardiac/etiology
MH  - Child
MH  - Child, Preschool
MH  - *Developing Countries
MH  - Female
MH  - Fontan Procedure
MH  - *Heart Bypass, Right
MH  - Heart Defects, Congenital/*surgery
MH  - Humans
MH  - Male
MH  - Postoperative Complications
MH  - Retrospective Studies
EDAT- 2003/12/31 05:00
MHDA- 2004/02/14 05:00
CRDT- 2003/12/31 05:00
PHST- 2003/12/31 05:00 [pubmed]
PHST- 2004/02/14 05:00 [medline]
PHST- 2003/12/31 05:00 [entrez]
AID - 292 [pii]
PST - ppublish
SO  - J Pak Med Assoc. 2003 Oct;53(10):506-9.