Bidirectional cavopulmonary shunt as a rescue procedure for right ventricular endomyocardial fibrosis

Abstract

The surgical treatment for patients with endomyocardial fibrosis consists of resection of endocardial fibrotic tissue and replacement or repair of atrioventricular valve. Even after endocardiectomy and valvular remodeling, some patients exhibit very poor hemodynamic profile because of myocardial failure due to long-standing restriction of ventricle or ventricles. Here, we report a case of endomyocardial fibrosis in right ventricle who underwent endocardiectomy and valvular replacement followed by bi-directional cavopulmonary shunt to compensate weaning failure from cardiopulmonary bypass. The long-term outcome and the indication of bi-directional cavopulmonary shunt has not been confirmed, although it was effective for saving the life of patients with low cardiac output and acute right ventricular failure.

Cavopulmonary anastomosis improves left ventricular assist device support in acute biventricular failure☆☆☆

“…The use of the surgical exclusion of the right ventricle in the treatment of isolated right ventricular dysfunction has been reported in experimental [17] and clinical studies [9][10][11]18]. Classical or modified Glenn connection seems to be capable of adequately maintaining the pulmonary circulation in the presence of right ventricular failure, as also observed in our model of biventricular collapse.…”

“…This procedure was also occasionally reported in the effective management of patients with postoperative refractory right ventricular dysfunction [9][10][11]. On the other hand, the concept of right ventricular surgical exclusion was never reported in association with a LVAD implantation for the treatment of acute biventricular failure.…”

Outcome of endocardiectomy in "Egyptian type" endomyocardial fibrosis: a report of two patients

“…While posterior leaflet suture bicuspidization is an accepted modality in the management of severe tricuspid regurgitation, this patient had residual regurgitation due to severe deformity of the tricuspid valve as a result of direct involvement of the fibrotic lesions in the right ventricle, papillary muscles, chordae and the annular tissues. In some patients, bypassing the right ventricle and the main pulmonary vessels may lead to a good outcome as illustrated by Yie et al who proposed a bidirectional cavopulmonary shunt as a rescue operation for patients who could not be weaned off bypass and described a successful utilization of this procedure in a case report [11]. This will be a very useful option in the management of these patients because it would lead to a reduction in venous inflow to the right ventricle and bypass main pulmonary artery.…”

Endomyocardial Fibrosis

“…Mobilization of the obliterated right ventricular trabecular portion in right-sided EMF and additional procedures such as Glenn procedure and atrial reduction have been recently used with promising results [52,76,77].…”