Systemic-pulmonary shunt for neonate and small infant with decreased pulmonary blood flow is an important first palliative surgery as simple palliation or complex palliative open-heart surgery to affect the completeness of subsequent radical or second surgery. It is important to understand the hemodynamics according to each disease and determine the shunt design considering the “shape” and “flow rate” of the shunt. In recent years, Blalock-Taussig shunt (BT shunt) and central shunt through median sternotomy have become mainstream, however conventional BT shunt through lateral thoracotomy is still an important basic procedure which pediatric cardiac surgeons should learn. Pulmonary artery banding (PAB) or bilateral PAB is also an important palliative procedure to protect the right and left pulmonary vascular beds equally for pulmonary high-flow complex heart disease and functional single ventricle. It is essential to perform secure PAB or bilateral PAB, which leads to the next procedure smoothly.

We evaluated risk factors for prolonged pleural effusion after surgery in 35 children who underwent total cavopulmonary connection (TCPC). Duration of their chest tube drainage was 5.4±7.0 days (1-41, median 3). In univariate analysis, significant risk factors for prolonged pleural drainage over 7 days were preoperative body weight (p=0.03), preoperative cardiothoracic ratio (p=0.03), cardiopulmonary bypass (CPB) time (p=0.02), homologous blood transfusion (p=0.03), serum protein concentration at CPB weaning (p=0.04), central venous pressure (CVP) averaged during 3 postoperative days (p=0.01) and body weight change during 3 postoperative days (p=0.01). However multivariate analysis showed only CVP averaged during 3 postoperative days was a significant risk factor for prolonged chest tube drainage (p=0.03, odd's ratio 3.3). In conclusion, to keep the central venous pressure as low as possible during the early postoperative period might decrease the duration of pleural drainage.