{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:36:55Z","timestamp":1787236615406,"version":"build-2736575974"},"reference-count":18,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"published-print":{"date-parts":[[1996,1]]},"abstract":"<jats:p>OBJECTIVE--To define the lowest age at which the bidirectional superior cavopulmonary anastomosis can safely be used in infants with complex congenital heart defects. DESIGN--A retrospective analysis of clinical, echocardiographic, haemodynamic, and angiographic data in four consecutive patients undergoing bidirectional superior cavopulmonary anastomosis below the age of 2 months. PATIENTS--Between November 1990 and September 1993, four infants less than 8 weeks of age (3, 4, 6, and 7 weeks) underwent bidirectional superior cavopulmonary anastomosis as a primary palliation for complex heart disease. The indication for early surgical intervention was progression of cyanosis (n = 3) and high pulmonary blood flow causing heart failure (n = 1). In two infants with tricuspid atresia, surgery was performed through a right thoracotomy without the use of cardiopulmonary bypass. In one infant with double inlet left ventricle and discordant ventriculoarterial connection, cavopulmonary anastomosis was combined with an arterial switch procedure. The final infant had double inlet left ventricle with pulmonary atresia; the central pulmonary arteries were virtually discontinuous and each branch was supplied by a separate arterial duct. The central pulmonary arteries were reconstructed using the subaortic innominate vein. Temporary prostacyclin infusion was used in three patients in the immediate postoperative period. RESULTS--Early postoperative extubation (5, 7, and 48 h) was successful in three patients. The youngest child required ligation of the ductus arteriosus four days later because of severe upper body oedema. The postoperative course was complicated by prolonged effusions in two patients. All were alive and well 14-48 months postoperatively, with satisfactory systemic saturations (80-87%) and haemodynamic indices. CONCLUSIONS--This limited experience challenges the widely held belief that the bidirectional superior cavopulmonary anastomosis cannot be used as a primary palliation for complex heart disease in early infancy. A wider experience is required to determine the safety and indications for this approach.<\/jats:p>","DOI":"10.1136\/hrt.75.1.78","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:46:00Z","timestamp":1190137560000},"page":"78-82","source":"Crossref","is-referenced-by-count":23,"title":["Bidirectional superior cavopulmonary anastomosis: how young is too young?"],"prefix":"10.1136","volume":"75","author":[{"given":"Z.","family":"Slavik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. K.","family":"Lamb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. A.","family":"Webber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. M.","family":"Devlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. R.","family":"Keeton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. L.","family":"Monro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. P.","family":"Salmon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1996,1,1]]},"reference":[{"key":"ref_1","first-page":"2128","article-title":"Bidirectional cavopulmonary anastomosis as interim palliation for high risk Fontan candidates: early results","volume":"88","author":"Bridges, N.D.; Jonas, R.A.; Mayer, J.E.; Flanagan, M.F.; Keane, J.F.; Castaneda, A.R.","year":"1993","unstructured":"Bridges ND, Jonas RA, Mayer JE, Flanagan MF, Keane JF, Castaneda AR. Bidirectional cavopulmonary anastomosis as interim palliation for high risk Fontan candidates: early results. Circulation 1993;88:2128-38.","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/S0022-5223(19)34670-7","article-title":"Bidirectional cavopulmonary anastomosis in patients under two years of age","volume":"104","author":"Albanese, S.B.; Carotti, A.; Di Donato, R.M.; Mazzera, E.; Troconis, C.J.; Giannico, S.","year":"1992","unstructured":"Albanese SB, Carotti A, Di Donato RM, Mazzera E, Troconis CJ, Giannico S, et al. Bidirectional cavopulmonary anastomosis in patients under two years of age. 7 Thorac Cardiovasc Surg 1992;104:904-9.","journal-title":"7 Thorac Cardiovasc Surg"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1016\/0003-4975(93)90340-N","article-title":"Mid-term results after bidirectional cavopulmonary shunts","volume":"56","author":"Hawkins, J.A.; Shaddy, R.E.; Day, R.W.; Sturtevant, J.E.; Orsmond, G.S.; McGough, E.C.","year":"1993","unstructured":"Hawkins JA, Shaddy RE, Day RW, Sturtevant JE, Orsmond GS, McGough EC. Mid-term results after bidirectional cavopulmonary shunts. 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Am J Cardiol 1993;71:959-62.","journal-title":"Am J Cardiol"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S0022-5223(19)35594-1","article-title":"The bidirectional cavopulmonary shunt","volume":"100","author":"Lamberti, J.J.; Spicer, R.L.; Waldman, J.D.; Grehl, T.M.; Thompson, D.; George, L.","year":"1990","unstructured":"Lamberti JJ, Spicer RL, Waldman JD, Grehl TM, Thompson D, George L, et al. The bidirectional cavopulmonary shunt. J Thorac Cardiovasc Surg 1990;100:22-30.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"ref_6","first-page":"149","article-title":"Early bidirectional cavopulmonary shunt in young infants. Postoperative course and early results","volume":"88","author":"Chang, A.C.; Hanley, F.L.; Wemovsky, G.; Rosenfeld, H.M.; Wessel, D.L.; Jonas, R.A.","year":"1993","unstructured":"Chang AC, Hanley FL, Wemovsky G, Rosenfeld HM, Wessel DL, Jonas RA, et al. Early bidirectional cavopulmonary shunt in young infants. 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