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Eur J Cardiothorac Surg 2006;30:414
© 2006 Elsevier Science NL

Letter to the Editor

Gore-Tex ‘new-innominate vein’ for complicated bilateral cavopulmonary shunts

Sachin Talwar, Shiv Kumar Choudhary*, Balram Airan

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi 110029, India

Received 2 April 2006; accepted 5 May 2006.

* Corresponding author. Address: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Tel.: +91 11 26588500; fax: +91 11 26588663. (Email: shivchoudhary{at}hotmail.com).

Key Words: Prosthetic graft • Innominate vein • Cavopulmonary shunt

We read with interest the case report "A Gore-Tex ‘new-innominate vein’: a surgical option for complicated bilateral cavopulmonary shunts" by Vida et al. [1]. We congratulate the authors for their innovative strategy in tiding over a troublesome situation following the bilateral cavopulmonary shunt (BCPS). However, certain reservations can be expressed over the initial management strategy planned for this patient. In the initial stage alone, considering a right pulmonary artery of only 3 mm size for a 14-month-old child (weight not specified), a left-sided systemic to pulmonary artery shunt would have provided an adequate initial palliation and considering that the pulmonary arteries were confluent, it would have probably led to the growth of the right pulmonary artery [2]. Previous experience has shown adequate growth of the pulmonary arteries after a systemic to pulmonary artery shunt [2], whereas their growth following a cavopulmonary shunt procedure is only a probability, particularly if the pulmonary arteries are not adequate in size [3–5]. Although the systemic to pulmonary artery shunt would have resulted in the volume overload of the systemic ventricle, the subsequent growth of the pulmonary arteries would probably have been better and avoided the unfortunate situation encountered by the authors. The risk of occlusion of the prosthetic graft when used as a systemic to pulmonary artery shunt would also have been less than its risk of occlusion between the two cavae, which the authors were forced to perform. Considering that the child was 14 months old, he could have then returned in the ensuing year for the BCPS with a more favourable pulmonary artery anatomy.

References

  1. Vida VL, Leon-Wyss J, Garcia F, Castaneda AR. A Gore-Tex ‘new-innominate’ vein: a surgical option for complicated bilateral cavopulmonary shunts. Eur J Cardiothorac Surg 2006;29:112-113.[Abstract/Free Full Text]
  2. Jahangiri M, Lincoln C, Shinebourne EA. Does the modified Blalock-Taussig shunt cause growth of the contralateral pulmonary artery?. Ann Thorac Surg 1999;67:1397-1399.[Abstract/Free Full Text]
  3. Iyer GK, Van Arsdell GS, Dicke FP, McCrindle BW, Coles JG, Williams WG. Are bilateral superior vena cavae a risk factor for single ventricle palliation?. Ann Thorac Surg 2000;70(3):711-716.[Abstract/Free Full Text]
  4. Mendelsohn AM, Bove EL, Lupinetti FM, Crowley DC, Lloyd TR, Beekman III RH. Central pulmonary artery growth patterns after the bidirectional Glenn procedure. J Thorac Cardiovasc Surg 1994;107:1284-1290.[Abstract/Free Full Text]
  5. Penny DJ, Pawade A, Wilkinson JL, Karl TR. Pulmonary artery size after bidirectional cavopulmonary connection. J Card Surg 1995;10:21-26.[Medline]




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Shiv Kumar Choudhary
Balram Airan
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