Results of Superior Vena Cava-to-Pulmonary Artery Shunt in the Treatment of Cyanotic Heart Disease

Since 1961, superior vena cava-to-pulmonary artery (SVC-PA) shunts have been performed in 31 patients with cyanotic heart disease. Of the 11 operative deaths, 8 were due to superior vena caval syndrome and 3 to pulmonary insufficiency. Superior vena caval syndrome was prevented in 8 consecutive patients by adjusting the degree of venous obstruction to keep superior vena caval pressure below 30 cm. H₂O. There were 3 late deaths among 17 patients who were followed for from one to nine years. All survivors experienced initial palliation, but only 4 of 13 patients followed for more than three years continued to do well. The other 9 patients developed more polycythemia and cyanosis, and 5 required reoperation with ligation of the left superior vena cava and collateral venous channels, together with creation of a systemic pulmonary artery shunt in 4. Late failure of the SVC-PA shunt appears to be the result of “venous steal” through the left superior vena cava and collateral venous channels together with progression of pulmonary stenosis.