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

Talwar, Sachin; Yadav, Mayank; Choudhary, Shiv Kumar

doi:10.1017/s1047951118002111

Cited by 3 publications

(1 citation statement)

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“…The fourth and fifth surgical options consist in a cavo-caval surgical connection: one of the SCV could be end-to-side anastomosed on the other one in order to create a configuration similar to that one of a unilateral Glenn with or without an interposition-graft ( 9 - 12 ). The direct cavopulmonary anastomosis was performed on the side of the larger SCV ( Figure 1D ) and in case of equal size, on the same side as the inferior caval vein ( 9 , 10 ). In case of insufficient length of the SCV, a rolled autologous pericardial graft or a polytetrafluoroethylene graft have been used to elongate the SCV to perform the cavo-caval anastomosis ( Figure 1E ) ( 11 , 12 ).…”

Section: Surgical Techniquesmentioning

confidence: 99%

Bilateral bidirectional cavopulmonary connection: a review of surgical techniques and clinical implications

Arrigoni,

Ebels

2024

Transl Pediatr

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The presence of bilateral superior caval veins (bSCVs) could negatively influence the outcome of Fontan patients. In the setting of a bilateral bidirectional Glenn, the selective blood flow to the ipsilateral long with consequent flow stagnation in the connecting portion could lead to poor growth of the central portion of the pulmonary artery, potentially affecting the eligibility for Fontan completion and being associated with a higher incidence of thrombotic complications. Alternative surgical techniques have been described to perform a bidirectional cavopulmonary anastomosis in the presence of bSCVs aiming to achieve a balanced growth of the pulmonary bifurcation. The short-term results of these techniques such as the V- or Y-shape seem to be excellent; however, some anatomical settings could affect the feasibility of these techniques. The so-called “unifocalization” creates a configuration comparable to a “normal” bidirectional Glenn and could be a feasible alternative. However, the long-term results of this technique are not published yet. The positive effect of additional pulsatile pulmonary flow on pulmonary artery growth should be considered in case of bilateral bidirectional Glenn, despite the higher incidence of postoperative complications reported and the difficult calibration of the amount of additional flow. The role of computational fluid dynamic to simulate the surgical strategy in single ventricle patients is promising and could be worthwhile in the setting of bSCVs. In fact, the surgical techniques of bilateral bidirectional Glenn could be simulated testing their feasibility and allowing to identify the more favorable hemodynamic pattern, patient specific. This review article highlights the critical issues related to the presence of bSCVs in univentricular physiology, analyzing pros and cons of the different surgical techniques. Besides reviewing the literature, this manuscript focuses on the role of computational fluid simulation in identifying the most favorable surgical technique with an individualized approach, which could potentially improve the clinical outcome.

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