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.