New approach in partial cavopulmonary connection

1998 ◽  
Vol 8 (3) ◽  
pp. 364-367 ◽  
Author(s):  
Paulo. P. Paulista ◽  
Maria Virginia. T. Santana ◽  
Antonio. T. M. Henriques Neto ◽  
Valmir F. Fontes
Keyword(s):  
Limiting Factor ◽  
Late Outcome ◽  
Caval Vein ◽  
New Approach ◽  
Inferior Caval Vein ◽  
Bidirectional Glenn Shunt ◽  
Show Evidence ◽  
The Right ◽  
Cavopulmonary Connection

AbstractThe development of pulmonary atteriovenous fistulas after bidirectional cavopuomonary operat-tions, such as the bidirectional Glenn shunt and Kawashima's procedure, has raised concern. Development of these fistulas, which are more frequent than initially thought, can represnt a limiting factor in the late outcome of these patients and may even limit the indication for these of surgery. Whether the fistulas can be reversed by transforming the surgical procedures has yet to be established. In the hope of avoiding this kind of complication, thought to be caused by the lack of passage of a hypothetical hepatic factor through the pulmonary circulation. wedevelped an inverred type of gidirectional cavopulmonary connection in which the blood coming from the liver perfuses immediately both lungs. This is made possi-ble by shuntiong via an intra-atrial tunnel the blood from the superior caval vein directly to the left atrium, and the blood from the inferior caval vein to the right branch of the pulmonary trunk (keeping its bifurcation intact). We describe findings in two patients undergoing successful surgery with this technique. Serial follow -up with cohtrast echocardiography did not show evidence of arteriovenous pulmonary fistulas.Despite our numbers being small, and the time of follow-up being limited, we believe that it is importantto document these and similar cases

Successful surgical repair of Uhl's anomaly

2002 ◽  
Vol 12 (2) ◽  
pp. 192-195 ◽  
Author(s):  
Nawal Azhari ◽  
Mervat Assaqqat ◽  
Ziad Bulbul
Keyword(s):  
Right Ventricle ◽  
Surgical Repair ◽  
Total Cavopulmonary Connection ◽  
Thromboembolic Stroke ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Bidirectional Glenn Shunt ◽  
Patch Closure ◽  
The Right ◽  
Cavopulmonary Connection

We report a case of Uhl's anomaly in a 5-month-old cyanotic infant who presented with thromboembolic stroke and acute hemiparesis. The patient underwent successfully an initial surgical repair, which included exclusion of the right ventricle by patch closure of the tricuspid valve, atrial septectomy and construction of a bidirectional Glenn shunt. This was followed by successful construction of a total cavopulmonary connection.

Scimitar syndrome associated with absence of the right pulmonary artery and a persistent primitive hepatic venous plexus

2005 ◽  
Vol 15 (2) ◽  
pp. 216-218 ◽  
Author(s):  
Gabriella Agnoletti ◽  
Damien Bonnet ◽  
Jacques De Blic
Keyword(s):  
Pulmonary Artery ◽  
Scimitar Syndrome ◽  
Venous Plexus ◽  
Caval Vein ◽  
Inferior Caval Vein ◽  
Right Pulmonary Artery ◽  
Unusual Variant ◽  
The Right

An 18-month-old boy, referred because of an infection of the airways, was found to have a right-sided heart, a hypoplastic right lung, absence of the right pulmonary artery, and persistence of the hepatic venous plexus. The benign association of this unusual variant of the scimitar syndrome and persistence of the hepatic venous plexus needs to be recognised in order to avoid extensive investigations and surgery involving the inferior caval vein.

Orthostatic hypotension and right heart failure as the initial manifestation of intravenous leiomyomatosis

2015 ◽  
Vol 26 (3) ◽  
pp. 586-588 ◽  
Author(s):  
Ya-Qin Li ◽  
Xiao-Ping Yin ◽  
Zhan-Wen Xu
Keyword(s):  
Right Atrium ◽  
Right Heart Failure ◽  
Intravenous Leiomyomatosis ◽  
Right Heart ◽  
Caval Vein ◽  
Initial Manifestation ◽  
Inferior Caval Vein ◽  
Mobile Mass ◽  
History Of ◽  
The Right

AbstractA 36-year-old woman, who had a history of myomectomy, presented with lightheadedness after changing position from sitting to standing and effort-related shortness of breath. Echocardiography demonstrated a hyperechoic elongated mobile mass extending from the inferior caval vein to the right atrium. The mass was surgically removed, and histological examination established the diagnosis of intravenous leiomyomatosis. This case caught the attention of our cardiology group to consider the diagnosis when an inferior caval vein or right atrium mass is found in a patient with a history of uterine leiomyomatosis.

Fontan completion in reverse order out of necessity: secondary Glenn after primary extracardiac inferior cavopulmonary artery connection

2016 ◽  
Vol 27 (5) ◽  
pp. 925-928 ◽  
Author(s):  
Jannika Dodge-Khatami ◽  
Avichal Aggarwal ◽  
Mary B. Taylor ◽  
Douglas Maposa ◽  
Jorge D. Salazar ◽  
...  
Keyword(s):  
Single Ventricle ◽  
Upper Body ◽  
Reverse Order ◽  
Venous Anatomy ◽  
Caval Vein ◽  
Single Ventricle Physiology ◽  
Superior Caval Vein ◽  
Good Outcome ◽  
Cavopulmonary Connection

AbstractThe primary extracardiac inferior cavopulmonary connection is an unusual novel palliation for single-ventricle physiology, which we first performed in the setting of unfavourable upper-body systemic venous anatomy for a standard bi-directional Glenn, and in lieu of leaving our patient with shunt-dependent physiology. After an initial 16-month satisfactory follow-up, increasing cyanosis led to the discovery of a veno-venous collateral that was coiled, but, more importantly, to impressive growth of a previously diminutive superior caval vein, which allowed us to perform completion Fontan with a good outcome. Performing the single-ventricle staging in a reverse manner, first from below with a primary inferior cavopulmonary connection, followed by Fontan completion from above with a standard superior caval vein bi-directional Glenn, is also possible when deemed necessary.

Congenitally palliated scimitar syndrome

2014 ◽  
Vol 25 (6) ◽  
pp. 1218-1220 ◽  
Author(s):  
Massimiliano Cantinotti ◽  
Raffaele Giordano ◽  
Isabella Spadoni
Keyword(s):  
Left Atrium ◽  
Rare Case ◽  
Pulmonary Veins ◽  
Scimitar Syndrome ◽  
Caval Vein ◽  
Anatomical Variant ◽  
Inferior Caval Vein ◽  
The Right

AbstractWe present a rare case of scimitar syndrome in which the scimitar vessel, collecting all the right pulmonary veins, was stenotic at its junction, with the inferior caval vein and two anomalous vessels, connecting to the same venous collector, draining most of the flow to the left atrium.We arbitrarily defined this rare anatomical variant as a congenitally palliated scimitar syndrome.

Totally anomalous pulmonary venous connection through the right lung and via a “Scimitar” vein to the inferior caval vein

1993 ◽  
Vol 3 (1) ◽  
pp. 85-87
Author(s):  
Rakesh Dua ◽  
Christine McTigue ◽  
James.L Wilkinson
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Left Lung ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Caval Vein ◽  
Inferior Caval Vein ◽  
The Right ◽  
Left Heart Syndrome ◽  
Anomalous Pulmonary Venous Connection

AbstractWe report a case of totally anomalous pulmonary venous connection in which the two pulmonary veins from the left lung joined to form a common vein which then passed across the midline into a hypoplastic right lung and, after receiving small veins from the right lung, passed inferiorly, exiting the lung below the hilum as a “scimitar” vein and terminating in the inferior caval vein. A separate pulmonary vein from the right lung passed inferiorly independently and joined the “scimitar” vein before it entered the inferior caval vein. There was an associated hypoplastic left heart syndrome.

Is the “Perfect Fontan” operation routinely achievable in the modern era?

2008 ◽  
Vol 18 (3) ◽  
pp. 328-336 ◽  
Author(s):  
James K. Kirklin ◽  
Robert N. Brown ◽  
Ayesha S. Bryant ◽  
David C. Naftel ◽  
Edward V. Colvin ◽  
...  
Keyword(s):  
Operative Procedure ◽  
Fontan Procedure ◽  
Fontan Operation ◽  
Pulmonary Arteries ◽  
Left Pulmonary Artery ◽  
Fontan Circulation ◽  
Caval Vein ◽  
Entire Cohort ◽  
Inferior Caval Vein ◽  
The Right

AbstractObjectiveIn 1990, Fontan, Kirklin, and colleagues published equations for survival after the so-called “Perfect Fontan” operation. After 1988, we evolved a protocol using an internal or external polytetraflouroethylene tube of 16 to 19 millimetres diameter placed from the inferior caval vein to either the right or left pulmonary artery along with a bidirectional cava-pulmonary connection. The objective of this study was to test the hypothesis that a “perfect” outcome is routinely achievable in the current era when using a standardized surgical procedure.MethodsBetween 1 January, 1988, and 12 December, 2005, 112 patients underwent the Fontan procedure using an internal or external polytetraflouroethylene tube plus a bidirectional cava-pulmonary connection, the latter usually having been constructed as a previous procedure. This constituted 45% of our overall experience in constructing the Fontan circulation between 1988 and 1996, and 96% of the experience between 1996 and 2005. Among all surviving patients, the median follow-up was 7.3 years. We calculated the expected survival for an optimal candidate, given from the initial equations, and compared this to our entire experience in constructing the Fontan circulation.ResultsAn internal tube was utilized in 61 patients, 97% of whom were operated prior to 1998, and an external tube in 51 patients, the latter accounting for 95% of all operations since 1999. At 1, 5, 10 and 15 years, survival of the entire cohort receiving polytetraflouroethylene tubes is superimposable on the curve calculated for a “perfect” outcome. Freedom from replacement or revision of the tube was 97% at 10 years.ConclusionUsing a standardized operative procedure, combining a bidirectional cavopulmonary connection with a polytetraflouroethylene tube placed from the inferior caval vein to the pulmonary arteries for nearly all patients with functionally univentricular hearts, early and late survival within the “perfect” outcome as predicted by the initial equations of Fontan and Kirklin is routinely achievable in the current era. The need for late revision or replacement of the tube is rare.

the partial cavo-pulmonary circulation with an additional source of pulmonary flow. an alternative to the total cavo-pulmonary circulation in patients with a functionally single ventricle

2004 ◽  
Vol 14 (S3) ◽  
pp. 62-65
Author(s):  
daniel sidi
Keyword(s):  
Pulmonary Circulation ◽  
Single Ventricle ◽  
Pressure Overload ◽  
Long Term Results ◽  
Early Completion ◽  
Caval Vein ◽  
Mortality And Morbidity ◽  
Inferior Caval Vein ◽  
The Right ◽  
Partial Connection

most paediatric cardiologists think that the optimal treatment for patients with functionally single ventricle is the relatively early construction, at from 2 to 7 years of age, of the total cavo-pulmonary circulation. this approach is based on the desire to produce an acyanotic child, such an outcome fostering the belief that the patient is cured. when using this therapeutic approach, the total connection is usually preceded by earlier creation of a partial connection, achieved by creating a bi-directional anastomosis between the superior caval vein and the right pulmonary artery at the age of from 3 to 9 months, without providing additional flow of blood to the lungs. this leads to severe cyanosis by the age of 3 years, when the flow increases in the inferior caval vein, and is the signal for early completion of the total connection. in this policy, the absence of additional flow to the lungs is justified by the fear of altering the ventricular function essential for the success of the total connection, because of the volume, and eventually the pressure, overload of the additional flow on the functionally single ventricle,which may impair its compliance and/or contractility, or be responsible for atrioventricular valvar regurgitation. these alterations in myocardial functions would then contraindicate, or increase, the mortality and morbidity of the total connection, producing deterioration in its long-term results.

global mathematical modelling of the norwood circulation: a multiscale approach for the study of the pulmonary and coronary arterial perfusions

2004 ◽  
Vol 14 (S3) ◽  
pp. 71-76 ◽  
Author(s):  
francesco migliavacca ◽  
katia laganà ◽  
giancarlo pennati ◽  
marc r. de leval ◽  
edward l. bove ◽  
...  
Keyword(s):  
Pulmonary Arteries ◽  
Systemic Circulation ◽  
Multiscale Approach ◽  
Pulmonary Perfusion ◽  
Pulmonary Shunt ◽  
Caval Vein ◽  
Inferior Caval Vein ◽  
Pulmonary Arterial ◽  
The Right ◽  
Blalock Taussig Shunt

the norwood procedure involves three separate stages of operative corrections. the first stage involves re-fashioning the pulmonary trunk into a neo-aorta so that it is possible to establish an unrestricted systemic circulation. an interpositional, or systemic-to-pulmonary arterial, shunt is then created between the neo-aorta and the pulmonary arteries to allow pulmonary perfusion and gas exchange. two of the available options for the systemic-to-pulmonary shunt are the central shunt and the right modified blalock-taussig shunt. in the setting of a central shunt, pulmonary perfusion is derived from a conduit placed between the pulmonary arterial bed and the neo-aorta whereas, in the modified blalock-taussig shunt, the conduit is interposed between one of the pulmonary arteries and the brachiocephalic artery. in subsequent stages, pulmonary perfusion is provided directly by deoxygenated blood. this is achieved by connecting, first, the superior caval vein, and then the inferior caval vein, to the pulmonary arteries. it is usually during the second stage that the systemic-to-pulmonary shunt is removed.

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