Total cavopulmonary connection in a 35-month-old Jehovah's Witness child.

JEHOVAH'S WITNESSES REJECT blood, plasma, or other blood components because of their literal interpretation of passages of the Bible.(1) Since the first report of cardiac surgery in Jehovah's Witnesses in 1964,(2) many successful cardiac operations have been performed in adult patients of this special entity.(3) Cardiac surgery in children of Jehovah's Witnesses, however, is a great challenge for the surgical team. Bloodless priming of the cardiopulmonary bypass (CPB) circuit may lead to severe hemodilution, especially in small children.(4) In addition, the risk of postoperative bleeding complications may be more relevant in congenital cardiac surgery because of the high percentage of redo operations. Finally, in patients receiving Fontan completions, hi.-h-volume requirement, especially of blood products, is indispensable to maintain an adequate transpulmonary gradient as a substitute for right ventricular function and to compensate for protein loss because of the unavoidably high systemic venous pressure. A case of an extracardiac total cavopulmonary connection in a 35-month-old child of Jehovah's Witnesses is reported. The child had a body weight of 13.7 kg at the time of the operation. The authors show that by using a minimized CPB circuit, modified ultrafiltration, the extracardiac technique for Fontan completion, and careful hemostasis the total cavopulmonary connection can be performed in small children without using blood products.