The BCPA (bidirectional cavopulmonary anastomosis) is an intermediate step in the modified Fontan operation. It is designed to increase the effective pulmonary blood flow and reduce the volume load on the ventricle.

The BCPA is often performed in conjunction with palliative surgery. It is an appropriate method of treatment for selected patients.

There is an increased risk of hypoxemia postoperatively. Using hyperventilation has not been shown to improve this condition.

The underlying cause of this problem is the increased pulmonary vascular resistance caused by cardiopulmonary bypass. In addition, there is a tendency for over assistance in spontaneous ventilation. This can lead to a decrease in MCA flow velocity, which reduces the rate of delivery of oxygenated blood into the systemic circulation.

For patients with a high risk of pulmonary venous obstruction, positive pressure ventilation is recommended. Deep sedation can also inhibit spontaneous inspiratory efforts. However, this may not be feasible after a BCPA.

Patients who have a favorable echocardiographic profile have moderate or less atrioventricular regurgitation, a normal proximal branch pulmonary artery size, and good ventricular function. These criteria were met in all but one patient.

There was no significant change in indexed EDA or ESA between the pre-BCPA and the BCPA interval. The median time of hospitalization was 8.5 days.

A non-invasive quantitative analysis of pulsatile blood flow and left to right lung flow ratio was performed in these patients. This method has the potential to be used to quantify the relative contribution of the BCPA to the perfusion of each lung.

In patients with bidirectional cavopulmonary anastomosis (BCPA) the superior vena cava connects directly to the pulmonary artery. Its function is to provide an improved pulmonary blood flow and volume load on the ventricle.

BCPA is a useful palliative procedure for selected patients. However, the effects of BCPA on cardiovascular physiology are complex. Several studies have suggested that different ventilatory techniques might influence cardiovascular outcomes. For example, hyperventilation, which stimulates the respiratory center, has been shown to be ineffective.

In addition to cardiovascular effects, mechanical ventilation can also be detrimental to patient health. In particular, hypercapnia with respiratory acidosis results in a decrease in pulmonary blood flow (PBF) and a higher rate of CBF. These changes can also lead to deep sedation and paralysis.

Consequently, BCPA is not suitable for all patients. Those who have a high risk of pulmonary venous obstruction should receive positive pressure ventilation.

The British Cardiac Patients Association (BCPA) recently commissioned a nationwide survey of cardiologists to identify cardiac surgeons who would consider performing BCPA. All patients were provided with informed consent and enrolled in the study.

A total of 23 patients with a median age of 10 months were included in the study. Median weight was 6.2 kg. Two patients had a ventricular septal defect, two had bilateral superior vena cavae and four had tricuspid atresia.

Before the BCPA, all patients were evaluated by cardiac catheterization. The results showed that echocardiographic criteria were favorable in 17 of the 23 patients. Among these, the echocardiographic parameters that were favorable were: a normal proximal branch pulmonary artery size, no ventricular outflow tract obstruction, moderate to less atrioventricular regurgitation, and good ventricular function.

The bidirectional superior cavopulmonary anastomosis (BCPA) is a technique which routes blood from the superior vena cava directly into the pulmonary artery. It is designed to increase the effectiveness of pulmonary blood flow.

A large number of patients have undergone BCPA with a relatively low rate of mortality. However, this procedure is not suitable for all patients, and requires special consideration. In addition, some patients have a risk of pulmonary venous obstruction, which would require positive pressure ventilation.

An innovative approach to BCPA has been developed which may reduce the risks of this surgery. This novel method is an intermediate stage of the modified Fontan operation.

In order to assess the physiological impact of this procedure, a retrospective analysis of all BCPA patients was carried out. Among the 23 patients studied, four had tricuspid atresia, two had atrioventricular septal defects, and four had hypoplastic right ventricles. All except one had prior palliative operations.

Compared with patients who underwent conventional CPB, the group who underwent BCPA had lower PA pressures. These pressures were calculated using the PA band gradient and systemic PA shunt velocity. Several favorable echocardiographic criteria were present, including normal proximal branch pulmonary artery size, good ventricular function, and moderate or less atrioventricular regurgitation.

The results indicate that a bidirectional superior cavopulmonary anastomosis can improve the effectiveness of pulmonary blood flow. Moreover, this method should be regarded as the preferred strategy for ventilation following the BCPA.

In addition, the interaction of the highly autonomically regulated vascular beds of the pulmonary and cerebral circulation is essential for post-BCPA physiology. This could have important clinical implications for early neurodevelopmental outcomes after the procedure.