The unifocal bilateral bidirectional cavopulmonary anastomosis.

We propose a new surgical technique to manage the presence of bilateral superior venae cavae in single ventricle patients, a recognized risk factor for both bidirectional Glenn anastomosis and Fontan completion. The idea is to convert two small, peripheral and competing bilateral bidirectional cavopulmonary anastomoses into a single, larger, and centrally located cavopulmonary connection. This technique, used in 2 patients, provides a symmetrical distribution of pulmonary blood flow and may, in fact, yield growth of the central pulmonary arteries as well as prevent thrombus formation.