Creation of Bidirectional Cavopulmonary Connections under Deep Conscious Sedation: A Modified Approach

Objectives: Early extubation after a surgically established cavopulmonary connection is state of the art. Transcatheter creation of a cavopulmonary connection was recently described in a patient who was judged as inoperable. To combine a minimal invasive procedure with the possibility of optimal hemodynamic conditions, we modified the procedure and were then able to perform it under deep conscious sedation.

Methods: This is a case series reporting on a new interventional technique to create a cavopulmonary anastomosis.

Result: We report on two patients who received a transcatheter cavopulmonary connection under deep conscious sedation. In both patients, the vessel-to-vessel connection was achieved by a venous access into the superior caval vein and direct needle puncture of the pulmonary artery. The two cavopulmonary anastomoses were held open by a covered stent and a bare metal stent, respectively.

Conclusion: To the best of our knowledge, this is the first report of creation cavopulmonary connections in deep conscious sedation. The procedure is straight forward, does not need special equipment and the hemodynamic-morphologic result is comparable to surgery.