239 zy Systemic Pulmonary Artery Shunt Using a Bovine Mesenteric Venous Graft in Newborns zyx Afksendiyos Kalangos, M.D., Ph.D., F.E.T.C.S., Maurice Beghetti, M.D., Jean-Claude Pache, M.D., Dominique Vala, M.D., and Bernard Faidutti, M.D. z Clinic for Cardiovascular Surgery, Division of Pediatric Cardiology, University Hospital of Geneva, Geneva, Switzerland ABSTRACT A new bovine mesenteric venous graft zyxwv 3 or 4 mm in diameter was used for per- forming systemic pulmonary artery shunts in six cyanotic newborns (aged 2 to zyx 30 days) from March 1997 onward. Clinical and echocardiographic studies proved that all shunts were patent and functioning well after an average of 8.8 months despite no postoperative anti- coagulation or antiplatelet regimen. Histological examination of t w o grafts explanted at the time of bidirectional cavopulmonary anastomosis showed no dense fibrotic mural infiltra- tion, calcification, or anastomotic hyperplasia. Bovine mesenteric venous grafts can be used for the construction of systemic pulmonary artery shunts with advantages similar to that of human vein allografts, such as the facility of implantation, good short- and mid-term pa- tency, easy takedown, and avoidance of complications presumably specific to polytetraflu- oroethylene. (J Card Surg 200 1; 15:239-243) Some infants born with complex heart dis- eases that cause restricted flow to pulmonary ar- teries still require systemic pulmonary artery shunts on an urgent basis. Creating shunts by in- terposing a tubular graft between systemic and pulmonary arteries in neonates has some advan- tages over other shunts, such as the classical Blalock-Taussig, Potts, and Waterston shunts, since the prostheses used to construct these shunts are usually made of expanded polytetra- fluoroethylene (PTFE).’r2 This article describes our clinical experience with six newborns in whom a new bovine mesenteric venous graft (ProCol, Hancock Jaffe Lab, Irvine, CA, USA) 3 or 4 m m in diameter was used to construct a sys- temic pulmonary artery shunt. Afksendiyos Kalangos, M D., Ph.D , zyxwvutsr F E T C.S., Clinic for Cardiovascular Surgery, University Hospital of Geneva, 24, rue Micheli-du-Crest, 121 1 Geneva, Switzerland. Fax. 41 22 3727634; e-mail. Afksendiyos Kalangos@hcuge.ch PATIENTS AND METHODS From March 1997 to January 2000, six con- secutive newborns with a mean age of 25 days (range 2 to 30 days) and a mean body weight of 2.7 kg (range 2.0 to 4.3 kg) underwent systemic pulmonary artery shunt using ProCol grafts 3 or 4 mm in diameter. Underlying cardiac malfor- mations included tetralogy of Fallot with pul- monary atresia in two patients, single ventricle with pulmonary atresia in two patients, pul- monary atresia with intact ventricular septum in one patient, and pulmonary atresia with ventric- ular septa1 defect in one patient. Two patients required infusion of prostaglandin E, to assure ductal patency. Preoperative oxygen saturation ranged from 45% to 75% with variable inspired oxygen concentrations (mean 62%). Our clinical experience with the ProCol graft began with a patient who initially had an aortic right pul- monary artery shunt with a 4-mm PTFE tube at the age of 23 days. The graft was replaced 5