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.