The Kawashima procedure is used for

congenital heart disease A congenital heart defect (CHD), also known as a congenital heart anomaly and congenital heart disease, is a defect in the structure of the heart or great vessels that is present at birth. A congenital heart defect is classed as a cardiovascular ...

with a single effective ventricle and an ''interrupted

inferior vena cava The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of th ...

'' (IVC). It was first performed in 1978 and reported in 1984. __TOC__

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 cava The superior vena cava (SVC) is the superior of the two venae cavae, the great venous trunks that return deoxygenated blood from the systemic circulation to the right atrium of the heart. It is a large-diameter (24 mm) short length vein th ...

(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 In human anatomy, the hepatic veins are the veins that drain venous blood from the liver into the inferior vena cava (as opposed to the hepatic portal vein which conveys blood from the gastrointestinal organs to the liver). There are usually thre ...

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.

References

Cardiac surgery Congenital heart defects {{Treatment-stub