Bidirectional cavopulmonary shunt for acute right ventricular failure in an adult patient.

Right ventricular failure due to right coronary occlusion is an uncommon but serious complication of acute aortic dissection. We report a patient with right coronary occlusion from acute type A aortic dissection who developed right ventricular failure that persisted after proximal aortic repair, rendering weaning from extracorporeal circulation unsuccessful. With a bidirectional cavopulmonary shunt and the use of an intraaortic balloon, the patient could be weaned successfully from cardiopulmonary bypass. This procedure may be an alternative to a right ventricular assist device in selected candidates.