Cavo pulmonary shunt

Cavo-pulmonary shunt: from the first experiments to clinical practice
Igor E. Konstantinov and Vladimir V. Alexi-Meskishvili
Ann Thorac Surg 1999;68:1100-1106

The online version of this article, along with updated information and services, is located
on the World Wide Web at:
http://ats.ctsnetjournals.org/cgi/content/full/68/3/1100

The Annals of Thoracic Surgery is the official journal of The Society of Thoracic Surgeons and the
Southern Thoracic Surgical Association. Copyright © 1999 by The Society of Thoracic Surgeons.
Print ISSN: 0003-4975; eISSN: 1552-6259.

Downloaded from ats.ctsnetjournals.org by on August 31, 2012

OUR SURGICAL HERITAGE

Cavo-Pulmonary Shunt: From the First Experiments
to Clinical Practice
Igor E. Konstantinov, MD, and Vladimir V. Alexi-Meskishvili, MD, PhD
Heart Institute for Children, Hope Children’s Hospital, Oak Lawn, Illinois, and German Heart Institute Berlin, Berlin, Germany

The cavo-pulmonary anastomosis is often referred to as sum of our modern knowledge. It seems timely, as we
Glenn shunt today. The concept of cavo-pulmonary enter the new millennium, to give due credit to those
shunting, however, was developed independently by individuals who put their minds and efforts into helping
many surgeons. While the work of some of them is sick children. These people deserve recognition.
widely recognized, the pioneering contributions of many
others fall into oblivion. Nonetheless, each of them (Ann Thorac Surg 1999;68:1100 – 6)
contributed something original and precious to the total © 1999 by The Society of Thoracic Surgeons

Les beaux esprits se rencontrent. if the blood of the superior vena cava should reach the
Great minds think alike. capillary region of the right lung by way of a convenient
—Voltaire (1694 –1778) anastomosis between the great venous trunk and the
Lettres philosophiques arterial system of the right lung. . . ” [3]. Further they
wrote: “We are not aware that anyone else has foreseen
Development of the cavo-pulmonary anastomosis is an
and studied the problem of oxygenation of the pulmo-
important landmark in surgical treatment of congenital
nary blood under venous pressure and without cardiac
heart disease. The anastomosis is often referred to as the
output” [3]. The anastomoses were made end-to-end
Glenn shunt. It is noteworthy, however, that this anasto-
between the proximal end of the divided azygos vein and
mosis was developed experimentally and introduced into
the right pulmonary artery with preatrial ligation of
clinical practice by many surgeons, working indepen-
superior vena cava (Fig 2).
dently and probably unaware of each other’s efforts.

Concept of Cavo-Pulmonary Shunt and the First
Experimental Studies
The right ventricular bypass was first successfully
achieved in 1949 by Rodbard and Wagner [1], who
worked at Michael Reese Hospital in Chicago. They
experimentally anastomosed the right atrial appendage
to the pulmonary artery and ligated the main pulmonary
artery and, thus, demonstrated the feasibility of the right
ventricular exclusion in chronic experiments on dogs.
However, it was not until 1950, when the concept of
cavo-pulmonary shunt was first introduced by Italian
surgeon Carlo A. Carlon (Fig 1) and his colleagues [2, 3].
The story of cavo-pulmonary shunt begins on March 27,
1950, at the Second Clinical Congress of the Italian
Chapter of the International College of Surgeons held in
Padua and Venice, when three Italian surgeons, Carlon,
Mondini, and de Marchi, presented their experimental
study of cavo-pulmonary shunt. The results of their
experimental study on 8 dogs were first published in 1950
in Italian [2] and in 1951 in English [3]. It was Carlo A.
Carlon, Professor of Surgery at the University Medical
School in Padua, who first advocated that in certain
congenital heart defects an “advantage would be served

Address reprint requests to Dr Konstantinov, Thoracic and Cardiovascu- Fig 1. Carlo A. Carlon. Courtesy of Dr Robicsek. (Reprinted with
lar Surgery, Mayo Clinic, 200 First St, SW, Rochester, MN 55905; e-mail: permission from Robicsek F. The history of right heart bypass before
konstantinov.igor@mayo.edu. Fontan. Herz 1992;17:199 –212.)

© 1999 by The Society of Thoracic Surgeons 0003-4975/99/$20.00
Published by Elsevier Science Inc PII S0003-4975(99)00877-2


Ann Thorac Surg HERITAGE KONSTANTINOV AND ALEXI-MESKISHVILI 1101
1999;68:1100 – 6 DEVELOPMENT OF THE CAVO-PULMONARY SHUNT

vena cava contributed to the death of several dogs.
Subsequently, this complication also created problems in
their clinical material [8]. On June 2, 1957, the Yale group
reported an extensive study of 75 dogs. In all but 7 of
these the anastomosis of the distal end of the divided
right pulmonary artery to the side of the superior vena
cava, utilizing the central stump of the divided azygos
vein as an anastomotic channel, was made. In the re-
maining 7 dogs, an end-to-end anastomosis was created
central to the azygos vein [9].

The First Direct End-to-End Anastomosis of the
Superior Vena Cava to the Right Pulmonary Artery
In 1954 Francis Robicsek (Fig 4) and colleagues from the
Department of Heart Surgery of the Post-Graduate Sur-
gical Clinic in Budapest undertook an experimental
study [9] and reported their initial results in the 1956
volume of Acta Medica Scandinavica [10]. In their study the
direct vena cava-to-pulmonary artery anastomoses were
done in about 15 minutes without cardiopulmonary by-
pass [10]. In 1956 Robicsek moved to the USA and, being
unaware of the work of Carlon, continued his experi-
Fig 2. Cavo-pulmonary anastomosis via the azygos vein—Carlon’s ments on cavo-pulmonary anastomosis with Paul W.
technique. (Reprinted with permission from Carlon CA, Mondini
Sanger in Charlotte, North Carolina. In 1959 they were
PG, de Marchi R. Surgical treatment of some cardiovascular dis-
eases. J Int Coll Surg 1951;16:1–11.)
able to achieve first clinical success.
In 1954 Harris B. Shumacker (Fig 5) performed a few

It is unknown why more than a decade elapsed be-
tween their experimental studies of 1950s and 1964, when
Carlon reported their first clinical experience [4]. Because
their initial reports appeared in journals scarcely read by
most surgeons, the pioneering work of Carlon and his
colleagues soon fell into oblivion. Although today Carlon
is seldom given an appropriate credit, it was he who first
described the concept of the cavo-pulmonary shunt [5].
It is our belief that the anastomosis between the right
pulmonary atery and azygos vein should be referred to as
Carlon’s technique. We are taking the liberty to do so
below.

The First Experimental Studies
After initial work of Carlon, the experiments on cavo-
pulmonary shunts continued by independent groups in
Hungary, Russia, and USA.

Cavo-Pulmonary Shunt via Azygos Vein—Carlon’s
Technique
In the 1954 volume of the Yale Journal of Biology and
Medicine, Glenn (Fig 3) and Patino published their first
experimental study on cavo-pulmonary shunts [6]. A
superior vena cava–right pulmonary artery shunt was
performed in 9 dogs using the azygos vein rather than by
direct caval anastomosis. The technique applied was very
similar to the technique described originally by Carlon.
The follow-up angiograms were done as late as postop-
erative day 13, and demonstrated patent anastomoses. In
1955 the Yale group reported a study of 59 operated dogs
with 6 long-term survivors [7]. Chylous pleural effusion Fig 3. William Wallace Lumpkin Glenn (1914 –). Courtesy of
secondary to elevated blood pressure in the superior Dr Glenn.


1102 HERITAGE KONSTANTINOV AND ALEXI-MESKISHVILI Ann Thorac Surg
DEVELOPMENT OF THE CAVO-PULMONARY SHUNT 1999;68:1100 – 6

experimental end-to-end anastomoses of the superior
vena cava and the right pulmonary artery, and the next
year he applied the technique in 2 patients [11, 12]. Many
surgeons at that time continued to anastomose the right
atrial appendage to the pulmonary artery [11, 12]. In
April 1955, Hurwitt said: “. . . further investigation will be
necessary before one may state whether or not anasto-
mosis of the right auricular appendage to the pulmonary
artery may be beneficial in a case of tricuspid atresia. The
circulatory by-pass of the right heart described by Glenn
and Patino, anastomosing the azygos vein to the right
pulmonary artery, and the anastomoses between the
venae cavae and the pulmonary artery referred to by
Shumacker represent provocative experiments in this
direction” [12].
It is often mentioned in surgical literature that the first
successful clinical cavo-pulmonary shunt was done and
reported in Russia. However, very little information is
available on what experimental studies preceded this
first success. Herein we describe this development in
more detail.
In Russia, the idea of the cavo-pulmonary anastomosis
was first proposed in September 1955 by Nikolai K.
Galankin (1914 –1977) and the first experimental success
was achieved the same year by Tigran M. Darbinian (Fig
6). In his PhD thesis published on May 14, 1957, Darbin- Fig 5. Harris B. Shumacker (1908 –). Courtesy of Dr Shumacker.
ian wrote:

In September 1955, N.K. Galankin suggested and de-
veloped in experiments on dogs a new operation—
anastomosis between periferal end of superior vena cava
and the right pulmonary artery. The operation was pro-
posed for children with tetralogy of Fallot and tricuspid
atresia. . . . In 1955, the anastomosis of the superior vena
cava was performed by Shumacker in 2 children with
pulmonary hypertension. The operations were not suc-
cessful. In the beginning of 1956, Robicsek, Temesvari,
and Kadar performed this operation in 15 dogs and
recommended it for patients with decreased pulmonary
flow. Thus, the anastomosis between superior vena cava
and the right pulmonary artery was developed simulta-
neously and independently by Galankin, Shumacker, and
Robicsek. It is noteworthy that Shumacker performed this
operation not for tetralogy of Fallot, but for transposition
of great arteries and truncus arteriosus communis, both
with pulmonary hypertension.
In 1954, Glenn and Patino partially bypassed the right
ventricle in 9 dogs by anastomosing the right pulmonary
artery and the azygos vein with ligation of the superior
vena cava below the anastomosis. . . . When we started
our experiments, the works of Shumacker and Robicsek
were not published yet.
Since September, 1955 we performed 46 experiments
on dogs. Of those we designed 34 chronic experiments to
study the long-term effects of the anastomosis. Six dogs of
those 34 died in the operating room, the rest of 28
survived and the long-term effects were studied. The
maximal period of study was 1 year.
Based on the idea of Galankin and our experiments on
long-term hemodynamic evalution of the cavo-pulmo-
nary anastomosis, Meshalkin successfully introduced this
operation in clinical practice in 1956 for patients with
Fig 4. Francis Robicsek (1925–). Courtesy of Dr Robicsek. tetralogy of Fallot and tricuspid atresia. That same year



Donetsky made a large diameter ring on my request, I
decided to give the idea the last try. Once, without saying
anything to Galankin, I took Donetsky with me and he
assisted me on the sixth dog. The dog survived.
I initially attributed it to the new technique; however,
subsequently, when I started the long-term evaluation I
noticed that this dog had previously been operated on the
left side. The left lung was adherent to the chest wall and
did not collapse. Dogs have very tiny pleural membranes
in between pleural cavities and may easily develop left
pneumothorax after the operation on the right. We
drained only the right pleural cavity on the first 5 dogs,
while the left lung was partially collapsed. The blood flow
via the anastomosis was impeded due to increased pul-
monary vascular resistance postoperatively, while the left
lung was collapsed!

Fig 6. Tigran Moiseevich Darbinian (1924 –) in the laboratory dur-
ing his first experiments on cavo-pulmonary anastomoses in 1955.
Courtesy of Dr Darbinian.

the operation was performed on a number of patients by
Vishnevsky and Galankin [13].

In Darbinian’s study, in 33 cases the anastomosis was
made end-to-end using Donetsky’s ring (Fig 7); in 13
cases, the anastomosis was made end-to-side and the
superior vena cava was side-clamped, in the same way
that was described by Glenn (Fig 8).
On December 6, 1998, Darbinian told us a very inter-
esting story on how the research was started:
I began my post-graduate training in the Vishnevsky’s
Institute of Surgery in Moscow in 1954. My supervisor
was Professor Nikolai K. Galankin. He had many patients
with tricuspid atresia, but had no effective means of
treatment. In 1955, he said to me: “Listen, why not to try
cavo-pulmonary anastomosis on dogs?” He operated on 5
dogs, I assisted him. All dogs died. It took ages to make
the anastomosis. We did not make any shunting of blood
and the pressure in the cross-clamped superior vena cava
was as high as 600 mm of water during the anastomosing.
Finally, he gave up, saying that nothing will come of it. He
said to me: “Apparently, my idea is wrong, but do not get
upset, I will soon invent something else.” He was, indeed,
a very keen-witted man. Meanwhile, I made a good friend
with Dr Donetsky. The latter headed the laboratory of
blood vessel conservation. Donetsky showed me his ring Fig 7. Donetsky’s ring. Technique of the end-to-side anastomosis
and his technique to connect blood vessels, which took using the stainless steel ring. (Reprinted from Donetsky DA. A new
only a few seconds. I talked him into helping me. After method of circular vascular suture. Eksp Khir 1956;1:53–9.)



I rushed to Galankin and told him about my success
and my conjecture. He was very happy but he has not
operated since that moment, he just smiled and said:
“Very well. Go ahead. This will be your PhD thesis.” I
started to inject talc into the left pleural cavity and
operated about 3 weeks after, so that adhesions could
develop and prevent left lung collapse after the operation.
All dogs survived.
When I operated on 6 more dogs, Galankin wrote an
article, with the meticulous description of the operative
technique and angiographic findings of patent anastomo-
ses, to the journal Eksperimentalnaja Khirurgia. The co-
editor of the journal was Meshalkin at the Institute of
Thoracic Surgery, and all manuscripts were submitted to
him. In 4 months our manuscript was returned and the
recommendation was given to at least double the number
of operations. In the meantime Meshalkin performed 4
clinical operations and presented them at the Moscow
Surgical Society meeting. Later on our article of a total of
13 experiments was published. After the initial clinical
success of Meshalkin, the operation was performed fre-
quently by Galankin at the Vishnevsky Institute of
Surgery.

As early as 1951, Professor A. N. Bakulev, head of the
Institute of Thoracic Surgery in Moscow, had proposed
the idea of the cavo-pulmonary anastomosis [14, 15].
However, it was not until successful experiments per- Fig 9. Evgenii Nikolaevich Meshalkin (1916 –1997). Courtesy of
Ms Arifulova, Deputy Director, Medical Museum of Russian Acad-
emy of Medical Sciences, Moscow.

formed by Darbinian that interest in the cavo-pulmonary
shunts was revived in Russia. The first articles on cavo-
pulmonary shunt in Russian literature were published in
1956 by Galankin and Darbinian [16], soon followed by a
clinical report of 24 cases by Evgenii N. Meshalkin (Fig 9)
[14].

The First Clinical Application
In the United States, the first to perform clinical cavo-
pulmonary shunts was Harris B. Shumacker. On Novem-
ber 15, 1954, at the Fortieth Annual Congress of the
American College of Surgeons in Atlantic City, Shu-
macker, discussing the article of Warden, mentioned the
experiments in his laboratory, in which the “venae cavae
were anastomosed directly to the pulmonary artery” [11,
12]. At the meeting, Shumacker also gave the first ac-
count of the clinical application of the cavo-pulmonary
shunt: “One was a very sick child who had truncus
arteriousus with pulmonary hypertension and large pul-
monary trunks coming off the common one. In this case
and in one case with complete transposition, we simply
performed a superior cava-right pulmonary artery end-
to-end anastomosis” [11, 12]. Unfortunately, both chil-
dren died 8 and 15 hours after the operation. The high
pulmonary vascular resistance most likely contributed to
Fig 8. Technique used by Glenn for the first clinical shunt on Febru-
ary 25, 1958. (Reprinted with permission from Glenn WWL. Circu-
death in both cases. Nonetheless, it was proven that “at
latory bypass of the right side of the heart. IV. Shunt between the least for periods of hours, the human heart can function
superior vena cava and distal right pulmonary artery: report of clin- with the right side circumvented” [12]. Although both of
ical application. N Engl J Med 1958;259:117–20. Copyright © 1958 Shumacker’s operations failed, it was an important and
Massachusetts Medical Society. All rights reserved.) brave step forward, particularly when it is remembered



shunting in Russia [21, 22]. Soon the final Russian tech-
nique was established, and was used with some modifi-
cations by most institutions in the Soviet Union. The
anastomosis was created by four techniques: (1) using
continuous U-shaped suture; (2) using interrupted single
U-shape staples; (3) using Donetsky’s ring; and (4) using
circular vascular stapler. The latter two methods had
their disadvantages: although with Donetsky’s ring the
diameter of the anastomosis was known precisely, it did
not allow for normal growth; the circular vascular stapler
required an extensive mobilization of the superior vena
cava and necessitated the ligation of the azygos vein [23],
although the azygos vein is ligated routinely by many
surgeons today. On November 24, 1958, Bakulev and
Kolesnikov submitted an article describing clinical expe-
rience with 41 cases at the Institute of Thoracic Surgery in
Moscow [15].
The first clinical report by Glenn [17] was published on
July 17, 1958. In the report Glenn described a 7-year-old boy
with transposition of the great vessels and decreased pul-
monary blood flow who, on February 25, 1958, underwent
cavo-pulmonary anastomosis (Fig 8). The child’s condition
was improved significantly and an angiogram performed 2
months later demonstrated patent anastomosis.
This was followed shortly by a successful operation
Fig 10. Russian technique. Similar technique was used by reported by Sanger, Robicsek, and Taylor [19]. They
Meshalkin for the first clinical shunt on April 3, 1956. (Reprinted performed their first clinical operation on January 9, 1959.
from Vishnevsky AA, Galankin NK. Congenital diseases of the heart
and great arteries [Russian]. Moscow, Russia: Meditsina,
1962:436 – 46.) Bidirectional Cavo-Pulmonary Shunt
The first bidirectional cavo-pulmonary shunt was per-
that it took almost 2 more years until Meshalkin performed successfully in a patient and reported in 1961 by
formed successful cavo-pulmonary shunts on patients in Achille Mario Dogliotti and associates in Turin, Italy [24].
Russia [14], and 4 years before Glenn [17], Rasmussen In 1964 independently from them, J. Alex Haller from the
[18], and Robicsek and colleagues [19] did so in the Johns Hopkins Hospital performed and reported the
United States and Santy and coworkers did so in France bidirectional superior vena cava-to-pulmonary artery
[20]. shunt [25]. Jose Patino and William Glenn used a tempo-
rary bidirectional superior vena cava–pulmonary artery
shunt in their first experiments in 1950s. They, however,
The First Clinical Success did not report the procedure at that time [26]. The
In 1956 in Russia, Meshalkin [14] presented the case bidirectional shunt as used by Patino and Glenn was not
summaries of 24 children on whom he performed cavo- an integral part of the operation but a temporary means
pulmonary anastomosis between April and October 1956. of expediting completion of a total bypass as used in their
Twenty-three of these patients had Fallot tetralogy and 1 experiments [26]. Independently from Dogliotti, Haller,
had pulmonary atresia. In all but 1 patient the anastomo- Patino, and Glenn, the bidirectional superior vena cava–
sis was done end-to-end, and in most cases the atrium pulmonary artery anastomosis was performed by
was closed with the UKL mechanical stapler (Institute for Gaetano Azzolina in 1968 in Italy [27].
Surgical Instruments, Moscow, Russia). Meshalkin used
a technique developed experimentally by Darbinian and
Galankin, except he did not apply a temporary azygos-
Epilogue
to-right atrium shunt (Fig 10). Three of 24 patients died. It often occurs in medicine that a syndrome or an
The patient Meshalkin operated on at the Institute of operation is named not after those by whom it was first
Thoracic Surgery in Moscow on April 3, 1956, represents described, but rather after those who convinced the
the first successful clinical case of cavo-pulmonary anas- world. William Glenn, was not the first to introduce the
tomosis reported in the world’s surgical literature. Sta- concept of cavo-pulmonary anastomosis. He reported
pling facilitated the operation and allowed completion of neither the first experimental study, nor the first clini-
the anastomosis in 5 to 6 minutes in experiments [16], cally successful operation. However, it was an extensive
and in 14 minutes in clinic [14, 15]. The initial success of study undertaken by the Yale University group and
Meshalkin stimulated further extensive studies on both prolific writing of Glenn published in the most-read
experimental and clinical aspects of the cavo-pulmonary surgical journals that finally convinced the world. By



virtue of experimental and clinical work, Glenn’s name D. Rationale of anastomosis of the right auricular appendage
is, generally, attached to the operation. Nonetheless, a to pulmonary artery in the treatment of tricuspid atresia.
remarkable pioneering contribution of many other sur- J Thorac Surg 1955;30:503–12.
13. Darbinian TM. Operative technique and hemodynamic eval-
geons, namely, Carlo Carlon, Francis Robicsek, Nikolai uation of the anastomosis of the superior vena cava and the
Galankin, Tigran Darbinian, Harris Shumacker, and Ev- right pulmonary artery [Russian]. Moscow, Russia: Na
genii Meshalkin should be remembered, respected, and Boevom Postu Publisher, 1957.
never regarded as just a historical curiosity. 14. Meshalkin EN. Anastomosis of the superior vena cava with
the pulmonary artery in patients with congenital heart
disease with blood flow insufficiency in the lesser circula-
We are indebted to Drs Tigran M. Darbinian, William W.L. tion. Eksp Khir 1956;6:3–12.
Glenn, Francis Robicsek, Harris B. Shumacker, and J. Alex Haller 15. Bakulev A, Kolesnikov SA. Anastomosis of superior vena
for their most valuable suggestions, profound interest in our cava and pulmonary artery in the surgical treatment of
work, and kind encouragement that made this article historically certain congenital heart defects of the heart. J Thorac Surg
correct and accurate. We are grateful to Ms Lutfia Arifulova, 1959;37;693–702.
Deputy Director, Medical Museum of Russian Academy of 16. Galankin NK, Darbinian TM. Anastomosis between the
Medical Sciences for providing us with documented superior vena cava and the right pulmonary artery: experi-
information. ment. Eksp Khir 1956;1:54–7.
17. Glenn WWL. Circulatory bypass of the right side of the
heart. IV. Shunt between the superior vena cava and distal
right pulmonary artery: report of clinical application. N Engl
References
J Med 1958;259:117–20.
1. Rodbard S, Wagner D. Bypassing the right ventricle. Proc 18. Rasmussen RA. Discussion of Kirklin JW, Ellis FH, McGoon
Soc Exp Biol Med 1949;71:69–70. DC. Surgical treatment for tetralogy of Fallot by open intra-
2. Carlon CA, Mondini PG, de Marchi R. Su una nuova cardiac repair. J Thorac Surg 1959;37:22–7.
anastomosi vasale per la terapia chirurgica di alcuni vizi 19. Sanger PW, Robicsek F, Taylor FH. Vena cava-pulmonary
cardiovasculari [A new vascular anastomosis for surgical artery anastomosis: III. Successful operation in case of com-
treatment of some cardiovascular anomalies]. Ital Chir 1950; plete transposition of the great vessels with intra-atrial
6:760 –5. septal defect and pulmonary stenosis. J Thorac Cadiovasc
3. Carlon CA, Mondini PG, de Marchi R. Surgical treatment of Surg 1959;38:166–71.
some cardiovascular diseases. J Int Coll Surg 1951;16:1–11. 20. Santy P, Marion P, Bret J, Estanove S. Success d’anastomose
4. Carlon CA, Tasca G, Guiliani G. Malattie cardiovasculari cavo-pulmonaire latero-terminale dans un cas d’atresie tri-
congenite [Congenital cardiovascular diseases]. Padua, Italy: cuspidienne [Successful cavo-pulmonary anastomosis in a
Piccin Editore, 1964. case of tricuspid atresia]. Lyon Chir 1959;55:603–5.
5. Robicsek F. The history of right heart bypass before Fontan. 21. Darbinian TM. Complications of vena cava-pulmonary ar-
Herz 1992;17:199 –212. tery anastomosis: an experimental study. Vestnik Khir 1957;
6. Glenn WWL, Patino JF. Circulatory by-pass of the right 5:52–5.
heart. I. Preliminary observations on the direct delivery of 22. Darbinian TM, Krymsky LD. Morphological changes in the
vena caval blood into the pulmonary arterial circulation: heart lungs and brain after experimental cavo-pulmonary
azygos vein-pulmonary artery shunt. Yale J Biol Med 1954; anastomosis. Bull Exp Biol Med 1959;47:105–9.
24:147–9.
23. Vishnevsky AA, Galankin NK. Congenital diseases of the
7. Patino JF, Glenn WWL, Guilfoil PH, Hume M, Fenn JE.
heart and great arteries [Russian]. Moscow, Russia:
Circulatory by-pass of the right heart II. Further observation
Meditsina, 1962:436– 46.
on vena-caval-pulmonary artery shunts. Surg Forum 1955;6:
189–91. 24. Dogliotti AM, Actis-Dato A, Venere G, Tarquini A.
8. Glenn WWL, Gardner TH, Talner NS, Stansel H, Matano I. L’intervento di anastomosi vena cava-arteria polmonare
Rational approach to the surgical management of tricuspid nella tetrade di Fallot e in altre cardiopatie [Surgical creation
atresia. Circulation 1968;38(Suppl 2):62–7. of the vena cava—pulmonary artery anastomosis in Fallot
9. Nuland SB, Glenn WWL, Guilfoil PH. Circulatory bypass of tetralogy and other cardiac pathology]. Minerva Cardioan-
the right heart. III. Some observations on long-term survi- giol 1961;9:577–93.
vors. Surgery 1958;43:184 –201. 25. Haller JA, Adkins JC, Rauenhorst J. Total bypass of the
10. Robicsek F, Temesvari A, Kadar RL. A new method for the superior vena cava into both lungs. Surg Forum 1964;15:
treatment of congenital heart disease associated with im- 264–5.
paired pulmonary circulation. Acta Med Scand 1956;154: 26. Glenn WWL. A temporary bidirectional superior vena cava-
151– 61. pulmonary artery shunt [Letter]. J Thorac Cardiovasc Surg
11. Shumacker HB. Discussion of Warden HE, DeWall RA, 1997;114:1123– 4.
Varco RL. Use of the right auricle as a pump for the 27. Azzolina G, Eufrate S, Pensa P. Tricuspid atresia: experience
pulmonary circuit. Surg Forum 1954;5:16–22. in surgical management with a modified cavopulmonary
12. Shumacker HB. Discussion of Hurwitt ES, Young D, Escher anastomosis. Thorax 1972;27:111–5.


Cavo-pulmonary shunt: from the first experiments to clinical practice
Igor E. Konstantinov and Vladimir V. Alexi-Meskishvili
Ann Thorac Surg 1999;68:1100-1106

Updated Information including high-resolution figures, can be found at:
& Services http://ats.ctsnetjournals.org/cgi/content/full/68/3/1100
References This article cites 16 articles, 3 of which you can access for free at:
http://ats.ctsnetjournals.org/cgi/content/full/68/3/1100#BIBL
Citations This article has been cited by 2 HighWire-hosted articles:
http://ats.ctsnetjournals.org/cgi/content/full/68/3/1100#otherarticles

Permissions & Licensing Requests about reproducing this article in parts (figures, tables) or
in its entirety should be submitted to:
http://www.us.elsevierhealth.com/Licensing/permissions.jsp or
email: healthpermissions@elsevier.com.
Reprints For information about ordering reprints, please email:
reprints@elsevier.com


Cavo pulmonary shunt

More Related Content

Similar to Cavo pulmonary shunt

Recently uploaded

Cavo pulmonary shunt