Case report - Cardiac general Bidirectional cavopulmonary shunt as a rescue procedure for right ventricular endomyocardial fibrosis

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. q 2003 Elsevier B.V. All rights reserved. 1. Case report A 31-year-old male patient was referred to us from a local clinic with a 7-year-history of NYHA class III dyspnea for further investigation and treatment. He had no past history of rheumatic fever during childhood or cyanosis at birth. Physical examination showed his jugular veins were not engorged. Low intensity of S1 sound was heard and S2 sound was widely split without fixation. A soft pansystolic murmur was heard at the right lower sternal border. No abnormal breathing sounds were heard in either lung field. Shifting dullness accompanied by hepatomegaly and mild pitting edema was also detected. Cardiothoracic ratio was 0.5 on the plain film and no other specific findings were noted. ECG showed sinus rhythm with a pattern of right bundle branch block in the precordial lead. Echocardio- graphic findings indicated that the septal leaflet of the tricuspid valve (TV) was apically displaced downward, creating an impressively large right atrium (RA) and very small right ventricle (RV) (Fig. 1). The motion of the interventricular septum (IVS) was paradoxical and grade