Abstract
Objective. To present a first experience with techniques axillary arteriovenous anastomosis in patients with functionally single ventricular after bidirectional cavopulmonary anastomosis (BDPA) and a high risk of the Fontan operation.
Introduction. Axillary arteriovenous anastomosis as a method of treatment of arterial hypoxemia in patients undergoing сavopulmonary anastomosis, is used in clinical practice for several decades. The increase in oxygen saturation after surgery may be caused either by closure of pulmonary arteriovenous fistulas, and due to the increase of pulmonary blood flow. However, the total number of patients operated on by this method is limited and the results are inconsistent.
Material and methods. We studied 7 patients with a variety of complex congenital heart defects (CHD) who underwent creation of an axillary arteriovenous anastomosis a median of 12 years after bidirectional cavopulmonary anastomosis. The age of patients ranged from 7 to 26 years, mean 19 years. Blood oxygen saturation was within 54–83%, averaging 70%. Indications for this operation were risk factors for the Fontan operation: severe arterial hypoxemia and polycythemia in all cases, hypoplasia of the pulmonary arteries in 3 cases, Gilbert’s syndrome with severe bilirubinemia in 1 case, renal failure in 1 case. Dimensions axillary vessels were assessed using Doppler ultrasound, volume and velocity flow rates of pulmonary circulation – by using magnetic resonance imaging (MRI).
Results. The postoperative period was no complications, well-being of patients had improved. Oxygen saturation at discharge increased on average by 10% and ranged from 67 to 89%, averaging 80%. Volumetric and speed characteristics of blood flow in the superior vena cava (SVC) and pulmonary arteries – growing impact on the average 1.5–2 times compared with the preoperative data. Long-term results were studied in 4 patients in a period of 6 months to 1 year after surgery. In all cases, the observed steady improvement, further enhancing blood oxygen saturation (84–93%), and exercise tolerance.
Conclusion. Patients with complex cyanotic CHD and a BDPA who are not candidates for or had failed Fontan operation, palliation with an axillary arteriovenous fistula improves pulmonary blood flow and increases arterial oxygen saturation.
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