A Gore-Tex ‘new-innominate’ vein: a surgical option for complicated bilateral cavopulmonary shunts

Abstract

A bilateral bidirectional cavopulmonary shunt was performed in a cyanotic 14-month-old girl who had tricuspid and pulmonary valve atresia, with right pulmonary artery (RPA) hypoplasia (3 mm), bilateral superior vena cavae and a ductus arteriosus-dependent pulmonary blood flow. Because of 62% postoperative arterial oxygen saturation and a right superior vena cava (RSVC) pressure of 30 mmHg, a 5 mm Gore-Tex tube was interposed to connect the two superior venae cavae. The creation of a 'new-innominate' vein allowed decompression of the right superior vena cava and an increase in arterial oxygen saturation to 86%.

Superior Cavopulmonary Anastomosis in Patients With Bilateral Superior Caval Veins: Use of a Rolled Pericardial Graft to Create a Single Caval Vein

“…Despite the good reported results, there is a concern about the possibility of conduit occlusion as well as the fixed size of the prosthesis in relation to subsequent growth of the patient. 4 …”

“…In order to improve the SVC blood flow, many ideas have been proposed: innominate vein formation by Gore-Tex prosthetic graft, 4 inferior anastomosis of two SVCs to form a venous confluence, 3 or other means of converting two SVCs into a single vessel, 2 including the use of an aortic homograft conduit. 5 …”

Unilateral unidirectional superior cavopulmonary anastomosis in a patient with bilateral superior caval veins and atretic left pulmonary artery

“…In a previous report from Guatemala, Vida and Castaneda have described a Gore-Tex interposition graft between the two superior caval veins creating "a Gore-Tex innominate vein". 5 Their technique is easy to perform and can be accomplished irrespective of the distance between the two superior caval veins. However, this graft has no growth potential and there is at risk of thrombosis requiring oral anticoagulant prophylaxis, with progressive occlusion of the graft in up to 30% patients within 3 years 6 and hence oral anticoagulants are needed.…”

Aldo R. Castañeda

“…Clinical research activities have begun, with most of the clinical studies undertaken subsequently published in prestigious international scientific journals. [91][92][93][94][95][96][97][98][99][100][101][102] Aldo has also trained three young foreign surgeons (Figs 4 and 5), in addition to the three members of his permanent surgical staff. These surgeons came from Venezuela, El Salvador, and one of us (VLV) from Italy.…”