Bidirectional Cavopulmonary Shunt for Right Ventricular Unloading.

ABSTRACT Background Right-sided heart failure remains a challenge in the care of congenital heart disease patients, both those with right ventricular dilation and dysfunction and those with right ventricular hypoplasia. Two strategies for treatment are atrial septal fenestration and bidirectional cavopulmonary shunt (BCPS). Methods This review details the strategies for right ventricular unloading, with summaries of pertinent data and commentaries on the subject. Results While atrial septal fenestration provides right ventricular unloading and can be appropriate in cases of moderate right ventricular dysfunction and dilation, this unloading is not as substantial as a BCPS. A BCPS more effectively unloads the right ventricle, provides preload to the left ventricle, and can significantly improve ventricular-ventricular interactions. A BCPS is often appropriate in cases of severe right ventricular dysfunction and dilation, if parameters favorable for BCPS circulation are in place. Certain anatomic and physiologic parameters assessed both preoperatively and intra-operatively help guide the decision regarding which patient may benefit from right ventricular unloading and which technique is optimal. Conclusions When employed strategically in select patients, BCPS and atrial level fenestration are effective in managing right ventricular failure in congenital heart disease patients. Pre-operative imaging and intra-operative anatomic and physiologic parameters help guide the appropriate management for a given patient.