Right ventricular failure due to right
coronary artery disease,
right ventricular hypertrophy, stunning, abnormal septal motion,
myocardial infarction, or non-homogeneous distribution of
cardioplegia is an uncommon but serious complication of open heart surgery. We report a patient with severe
right ventricular hypertrophy secondary to severe
mitral valve stenosis and another patient with detachment of the right coronary artery due to the dissection of the ascending aorta. The patients developed right ventricular failure, which persisted after surgery and rendered weaning from
cardiopulmonary bypass unsuccessful. Through a hemi-Fontan, or
bidirectional cavopulmonary shunt, and an intra-aortic balloon pump, the patients were successfully weaned from
cardiopulmonary bypass. This shunt may be an alternative to a right
ventricular assist device in some patients with right ventricular failure. The long-term outcome and the indication of bi-directional
cavopulmonary shunt has not been confirmed, although it is believed to be effective for saving the life of patients with
low cardiac output and acute right ventricular failure. In our cases, six months following the operation, there was some degree of recovery of the right ventricular function. In long-term follow-up, however, it would be interesting for the authors to know if the improved right ventricular function, with better antegrade pulsatile flow in the pulmonary artery, in any way interferes with the functioning of the
bidirectional cavopulmonary shunt.