Veno-venous shunt-assisted cavopulmonary anastomosis

Does Extrathoracic Jugulo-Femoral Venous Shunt Avoid Cardiopulmonary Bypass in Glenn Bi-Directional Shunt Procedure?

OBJECTIVE

The aim of the present study was to evaluate the efficacy of extrathoracic jugulo-femoral venous shunt (JFVS) in avoiding the need for cardiopulmonary bypass (CPB) during the bi-directional Glenn shunt (BDGS) procedure.

METHODS

A total of 40 patients aged between 9 and 36 months were enrolled in the present study. The patients were classified into two groups, group A (n=20) in which the patients had no veno-venous shunt and group B (n=20) in which the patients had extrathoracic JFVS. Patients requiring CPB, arterial oxygen saturation (SaO2), heart rate, mean arterial pressure (MAP) and central venous pressure (CVP) were recorded during surgery. Postoperative time of intubation, intensive care unit (ICU) and hospital length of stays and neurological complications were also recorded.

RESULTS

The number of patients who needed urgent CPB was greater in group A than in group B. Intraoperative MAP was significantly lower in group A than in group B 10 min after clamping of the superior vena cava (SVC) and 30 min after declamping of the SVC. The CVP was significantly lower, and arterial SaO2 was significantly higher in group B than in group A 10 min after clamping of the SVC. The duration of postoperative intubation was significantly shorter in group B than in group A, and the ICU length of stay was shorter in group B than in group A. The hospital length of stay was similar in both groups. Postoperative neurological deficits were comparable in both groups.

CONCLUSION

The use of extrathoracic JFVS during the BDGS procedure avoided the use of CPB, maintained MAP and prevented any significant increase in SVC pressure.

Developing congenital heart surgery in India: The travails and triumphs of a pioneer

Professor IM Rao, from All India Institute of Medical Sciences, New Delhi, was a pioneering cardiac surgeon who, against overwhelming odds, developed congenital heart surgery in India. He made many contributions to the evolution of his specialty, spanning more than four decades and three countries. This is a brief report of his professional life and accomplishments.

New technique of off-pump atrial septostomy for complex congenital cardiac anomalies

OBJECTIVES

Atrial septostomy is essential for palliation of some complex congenital cardiac anomalies, such as transposition of the great arteries and left-/right-sided atrioventricular valve stenosis or atresia. Conventionally, balloon atrial septostomy is done in neonates. Beyond the neonatal period, surgical septostomy is done using cardiopulmonary bypass and can lead to increased morbidity and mortality. We report a new technique of atrial septostomy without cardiopulmonary bypass and its follow-up.

METHODS

Eleven cases underwent atrial septostomy without using cardiopulmonary bypass from January 2009 to June 2010. Median age of patients was 7 months (2-12 months) and median weight was 6.3 kg (range 4.5-10 kg). Surgical septostomy was performed through the right atrial appendage with a Tubb's dilator, aided by intra-operative transesophageal echocardiography. Atrial septal defect (ASD) less than 5mm was enlarged with a Kerrison bone punch and then dilated with a Tubb's dilator. Associate procedures performed were off-pump Glenn in seven cases, pulmonary artery (PA) banding in three cases, and shunt with PA band in one case.

RESULTS

All the restricted ASDs were successfully enlarged with adequate interatrial shunting without any gradient. Echocardiography revealed no evidence of introduction of air or particulate emboli, and no tricuspid valve injury or heart block. There was no postoperative mortality. Follow-up ranged from 1 to 18 months (median 11 months). Echocardiography showed good PA band gradient/well-functioning Glenn shunt and unobstructed ASD with good oxygen saturation.

CONCLUSIONS

This technique demonstrates the surgical feasibility of a beating-heart atrial septostomy. It avoids the adverse effects of cardiopulmonary bypass, reduces morbidity, and has no mortality. It is safe, economical, and easily reproducible. To our knowledge, this technique has not been reported in literature so far.