Modified Fontan Procedure: Atrial Baffle and Systemic Venous to Pulmonary Artery Anastomotic Techniques

1988 ◽  
Vol 3 (2) ◽  
pp. 91-96 ◽  
Author(s):  
RICHARD A. JONAS ◽  
ALDO R. CASTANEDA
Keyword(s):  
Pulmonary Artery ◽  
Fontan Procedure ◽  
Anastomotic Techniques

Various Anastomotic Techniques for Size Mismatch in Pulmonary Artery during Lung Implantation

2019 ◽  
Vol 38 (4) ◽  
pp. S419-S420
Author(s):  
Y. Yokoyama ◽  
T. Chen Yoshikawa ◽  
Y. Yamada ◽  
Y. Yutaka ◽  
D. Nakajima ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Size Mismatch ◽  
Anastomotic Techniques

Modified Fontan Procedure with the Simultaneous Bidirectional Cavopulmonary Shunt

1995 ◽  
Vol 3 (1) ◽  
pp. 29-34
Author(s):  
Kim Yong Jin ◽  
Jun Tae Gook ◽  
Lee Jeong Ryul ◽  
Rho Joon Ryang ◽  
Suh Kyung Phill
Keyword(s):  
Pericardial Effusion ◽  
Pulmonary Artery ◽  
Fontan Procedure ◽  
Vena Cava ◽  
Right Atrial ◽  
Postoperative Arrhythmia ◽  
Bidirectional Cavopulmonary Shunt ◽  
Group 2 ◽  
Cavopulmonary Shunt ◽  
Group 1

We reviewed our experience of 56 patients from 1989 to 1992 who underwent a modified Fontan procedure and a bidirectional cavopulmonary shunt simultaneously. There were 39 male and 17 female patients and their weight ranged from 6.54 to 29kg (mean weight 13.58 ± 3.96kg). Patient age ranged from 16 to 135 months (mean age 42.8 ± 3.7 months). Diagnoses included single ventricle in 29, tricuspid atresia in 11, double outlet of right ventricle in 10, hypoplastic left heart syndrome in 4, and pulmonary atresia with intact ventricular septum in 2 patients. The techniques of inferior vena cava to pulmonary artery (IVC-PA) connection were anastomosis of proximal superior vena cava (SVC) to pulmonary artery (PA) in 27 (group 1), direct atriopulmonary anastomosis with roof formation in 29 patients (group 2). There were significant differences in postoperative 1-hour right atrial (RA) pressure and period of chest tube drainage between group 1 and group 2. The early mortality was 12.5% (7/56), and 2 late deaths (4.1%) occurred with a mean follow-up period of 22.4 months. Risk factors for the late postoperative arrhythmia were immediate postoperative arrhythmia and prolonged pleuro-pericardial effusion. Direct connection of the remaining proximal SVC to PA with the bidirectional cavopulmonary shunt may have less pleuro-pericardial effusion and late arrhythmia than atriopulmonary anastomosis.

Single-Stage versus Two-Stage Modified Fontan Procedure

2007 ◽  
Vol 15 (4) ◽  
pp. 327-331 ◽  
Author(s):  
Sukasom Attanavanich ◽  
Alisa Limsuwan ◽  
Suthep Vanichkul ◽  
Panuwat Lertsithichai ◽  
Montein Ngodngamthaweesuk
Keyword(s):  
Pulmonary Artery ◽  
Fontan Procedure ◽  
Volume Overload ◽  
Single Stage ◽  
Two Stage ◽  
Bidirectional Glenn ◽  
Atrioventricular Valve Regurgitation ◽  
Bidirectional Glenn Shunt ◽  
Significant Difference ◽  
Before And After

We compared surgical outcomes of the single-stage and two-stage modified Fontan procedures to clarify clinical superiority. Of 28 children undergoing a modified Fontan procedure from October 1995 to October 2005, 15 had a 1-stage and 13 had a 2-stage operation. In the 2-stage group, pulmonary artery growth was evaluated before and after the first stage. Operative mortality was 26.6% in the 1-stage group and 0% in the 2-stage group. The benefits of a previous bidirectional Glenn shunt were decreased cyanosis and volume overload, but there was no significant difference in pulmonary artery growth reflected in pulmonary artery indices before and after the bidirectional Glenn procedure. Older children underwent a 2-stage modified Fontan procedure and had better outcomes in terms of lower mortality, improved oxygen saturation, decreased volume load, and less deterioration of atrioventricular valve regurgitation.

Monitoring pulmonary artery pressure in children undergoing the Fontan procedure

2013 ◽  
Vol 21 (3) ◽  
pp. 303-305 ◽  
Author(s):  
Sumit Vasdev ◽  
Sandeep Chauhan ◽  
Sachin Talwar ◽  
Anil Pandey ◽  
Usha Kiran
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Fontan Procedure ◽  
Artery Pressure

Hemodynamics Characteristics of a Four-Way Right-Atrium Bypass Connector With an Optimized Central Diverter

2018 ◽  
Author(s):  
Elizabeth Mack ◽  
Jakin Jagani ◽  
Alexandrina Untaroiu
Keyword(s):  
Pulmonary Artery ◽  
Inferior Vena Cava ◽  
Stagnation Point ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Power Loss ◽  
Inferior Vena ◽  
Superior Vena ◽  
Fontan Procedure ◽  
Vena Cava

The most common surgical procedure used to treat right ventricular heart failure is the Fontan procedure, which connects the superior vena cava and the inferior vena cava directly to the left and right pulmonary arteries bypassing the right atrium. Many studies have been performed to improve the Fontan procedure. Research has been done on a four-way connector that can both passively and actively improve flow characteristics of the junction between the Superior Vena Cava (SVC), Inferior Vena Cava (IVC), Left Pulmonary Artery (LPA) and Right Pulmonary Artery (RPA), using an optimized connector and dual propeller system. However, the configuration of these devices do not specify propeller motor placement and has a stagnation point in the center of the connector. This study focuses on creating a housing for the motor in the center of the connector to reduce the stagnation area and further stabilize the propellers. To do this, we created a program in ANSYS that utilizes the design-of-experiment (DOE) function to minimize power-loss and stagnation points in the connector for a given geometry. First, a CFD model is created to simulate the blood flow inside the connector with different housing geometries. The shape and size of the housing are used as parameters for the DOE process. In this study, an enhanced central composite design technique is used to discretize the design space. The objective functions in the DOE are red blood cell residence time and power loss. It was confirmed that the addition of the housing did decrease the size of the stagnation point. In fact, the housing added in stabilizing the flow through the connector by creating a more defined flow path. Because the flowrates from the IVC and SVC are not the same, the best configuration for the housing was found to be asymmetric along the axis of the pulmonary artery. While this is a continuation of previous studies, the creation of an optimized housing for the motors for the propellers makes implementation of the propeller idea more viable in a real life situation. The added stability of the propellers provided by the housing can also decrease the risk of propeller failure due to rotordynamic instability.

scholarly journals Aortopulmonary Collateral Flow Is Related to Pulmonary Artery Size and Affects Ventricular Dimensions in Patients after the Fontan Procedure

PLoS ONE ◽  
2013 ◽  
Vol 8 (11) ◽  
pp. e81684 ◽  
Author(s):  
Heiner Latus ◽  
Kerstin Gummel ◽  
Tristan Diederichs ◽  
Anna Bauer ◽  
Stefan Rupp ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Fontan Procedure ◽  
Collateral Flow ◽  
Aortopulmonary Collateral ◽  
Ventricular Dimensions

scholarly journals Use of Pericardial Patch Conduit in Bidirectional Glenn Shunt: An Innovative Technique

2020 ◽  
Vol 13 (1) ◽  
pp. 92-94
Author(s):  
Kazi Shariful Islam ◽  
Shahriar Moinuddin ◽  
Ankan Kumar Paul ◽  
Masud Alam
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Stenosis ◽  
Fontan Procedure ◽  
Left Pulmonary Artery ◽  
Intermediate Step ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Palliative Procedure ◽  
Bidirectional Glenn Shunt ◽  
Right Pulmonary Artery

Bidirectional Glenn Shunt is a palliative procedure in single ventricle or hypoplastic right ventricle, tricuspid atresia and pulmonary stenosis complex where definitive repair is not feasible as well as a intermediate step of Fontan procedure. It is done by anastomosing superior venacava with right pulmonary artery or conduit can be used. We were forced to do the anastomosis between superior venacava and left pulmonary artery using a conduit as anatomy wasn’t favorable. Due to unavailability of any recognized conduits we used autologous pericardium and created a conduit with it to carry out anastomosis. Post-operative results were satisfactory. Cardiovasc. j. 2020; 13(1): 92-94

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