Kawashima procedure
Encyclopedia
The Kawashima procedure is used for congenital heart disease with a single effective ventricle and an interrupted inferior vena cava
(IVC). It was first performed in 1978 and reported in 1984.
(SVC). Therefore, the redirection of SVC blood to the lungs (as in the Glenn) results in much more than half the venous blood flow being diverted.
After Kawashima, the only de-oxygenated blood returning to the heart is from the abdominal organs (via the hepatic vein
s)). As a result, there is much less hypoxia
than after Glenn, and the heart is pumping less additional blood than after Glenn. However, the hypoxia can worsen over time (because of the development of microscopic AVMs
in the lungs that allow blood to pass through without being oxygenated), and therefore these children still may need a complete Fontan procedure
in the end.
Inferior vena cava
The inferior vena cava , also known as the posterior vena cava, is the large vein that carries de-oxygenated blood from the lower half of the body into the right atrium of the heart....
(IVC). It was first performed in 1978 and reported in 1984.
Procedure
Technically it is very similar to the Bidirectional Glenn procedure used to direct half the body's venous blood flow into the lungs. However, in patients with interrupted IVC, most of the blood from the lower body actually joins the blood from the upper body before returning to the heart via the superior vena cavaSuperior vena cava
The superior vena cava is truly superior, a large diameter, yet short, vein that carries deoxygenated blood from the upper half of the body to the heart's right atrium...
(SVC). Therefore, the redirection of SVC blood to the lungs (as in the Glenn) results in much more than half the venous blood flow being diverted.
After Kawashima, the only de-oxygenated blood returning to the heart is from the abdominal organs (via the hepatic vein
Hepatic vein
In human anatomy, the hepatic veins are the blood vessels that drain de-oxygenated blood from the liver and blood cleaned by the liver into the inferior vena cava....
s)). As a result, there is much less hypoxia
Hypoxia (medical)
Hypoxia, or hypoxiation, is a pathological condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise...
than after Glenn, and the heart is pumping less additional blood than after Glenn. However, the hypoxia can worsen over time (because of the development of microscopic AVMs
Arteriovenous malformation
Arteriovenous malformation or AVM is an abnormal connection between veins and arteries, usually congenital. This pathology is widely known because of its occurrence in the central nervous system, but can appear in any location. An arteriovenous malformation is a vascular anomaly. It is a...
in the lungs that allow blood to pass through without being oxygenated), and therefore these children still may need a complete Fontan procedure
Fontan procedure
The Fontan procedure, or Fontan/Kreutzer procedure, is a palliative surgical procedure used in children with complex congenital heart defects. It involves diverting the venous blood from the right atrium to the pulmonary arteries without passing through the morphologic pulmonary ventricle...
in the end.