scholarly journals Catheter ablation of macroreentrant atrial tachycardias following transconduit puncture access in a patient after total cavopulmonary connection with an extracardiac conduit

2021 ◽  
Vol 27 (3) ◽  
pp. 113-122
Author(s):  
Vassil Traykov ◽  
Tchavdar Shalganov ◽  
Lyubomir Dimitrov ◽  
Anna Kaneva ◽  
Stojan Lazarov ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Pulmonary Veins ◽  
Balloon Dilation ◽  
Right Atrial ◽  
Ventricular Rate ◽  
Complex Congenital Heart Disease ◽  
Total Cavopulmonary Connection ◽  
Surgical Interventions ◽  
Extracardiac Conduit ◽  
Cavopulmonary Connection

We present the case of a 23-year-old male diagnosed with a complex congenital heart disease (with single ventricle physiology) which necessitated many surgical interventions including total cavopulmonary connection. The patient presents with recurrent (almost daily) highly symptomatic atrial tachycardia with rapid ventricular rate and poor haemodynamic tolerance. Due to failure of antiarrhythmic drug therapy the patient was referred for catheter ablation. Atrial access was provided following transconduit puncture with a standard transseptal set. Crossing to the atrium with the transseptal introducer was not successful due to resistance from the conduit and the atrial wall. Therefore, balloon dilation of the puncture using a cutting balloon was carried out which resulted in easy crossing to the atrium with a steerable transseptal introducer. Several atrial tachyarrhythmias were induced two of which allowed mapping demonstrating a macroreentrant tachycardia dependent on the cavoannular isthmus as well as a complex fi gure-of-eight circuit involving right pulmonary veins and the right atrial appendage. Linear lesions transecting the critical isthmuses of the two circuits were delivered which rendered the patient noninducible. During a 9-month follow-up period the patient remained arrhythmia free.

Abstract 11582: Catheter Ablation of Supraventricular Tachycardia in Patients With Total Cavopulmonary Connection

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Keiko Toyohara ◽  
Tomomi Nishimura ◽  
Morio Shoda ◽  
Toshio Nakanishi
Keyword(s):  
Catheter Ablation ◽  
Supraventricular Tachycardia ◽  
Fontan Operation ◽  
Accessory Pathway ◽  
Total Cavopulmonary Connection ◽  
Transseptal Puncture ◽  
Atrioventricular Reentrant Tachycardia ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Cavopulmonary Connection

Introduction: Management of arrhythmias after the Fontan operation is difficult. Total cavopulmonary connection (TCPC), rather than atriopulmonary connection, is considered the optimal method to minimize the risk of arrhythmias, although they are sometimes still observed after TCPC. Catheter ablation (CA) for supraventricular tachycardia (SVT) is extremely difficult after TCPC because the systemic venous route is excluded from the atria. The purpose of this study was to evaluate the efficacy of CA in treating SVT after TCPC. Results: CA was attempted after TCPC in 14 patients aged 8-37 years (median: 23 years). TCPC was performed using the lateral tunnel approach in 5 patients, the intra-atrial conduit procedure in 2, and the extracardiac polytetrafluoroethylene conduit procedure in 7. During CA, the atrium was approached either by a transseptal puncture (12 patients), a fenestration in the patch (1 patient), or suture leakage (1 patient). Transseptal puncture was performed using a conventional Brockenbrough needle in all 12 patients. There were no clinically significant complications and only one unsuccessful puncture. SVT included atrial flutter in 4 patients, atrial tachycardia in 7, atrioventricular reentrant tachycardia (AVRT) via the accessory pathway in 1, and AVRT involving twin atrioventricular nodes in 2. Acute treatment of SVT with CA was achieved in 10 patients (71%), but tachycardia recurred in 3 during follow-up. Deterioration of cyanosis was not observed after transseptal puncture, and closure of the puncture site was confirmed in all 12 patients. Overall, SVT was successfully managed using CA in 7 out of 14 patients (50%), and with medication in the remaining patients. Conclusions: SVT may arise after the TCPC procedure. Puncture of the extracardiac conduit is feasible, and CA can be an effective treatment option for refractory SVT after TCPC.

scholarly journals Do we need fenestration when performing two-staged total cavopulmonary connection using an extracardiac conduit?☆

2009 ◽  
Vol 9 (1) ◽  
pp. 50-54 ◽  
Author(s):  
Yorikazu Harada ◽  
Shunji Uchita ◽  
Takahiko Sakamoto ◽  
Mitsuhiro Kimura ◽  
Kentaro Umezu ◽  
...  
Keyword(s):  
Total Cavopulmonary Connection ◽  
Extracardiac Conduit ◽  
Cavopulmonary Connection

scholarly journals Catheter ablation of supraventricular tachycardia in patients with total cavopulmonary connection

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P2315-P2315
Author(s):  
K. Ikeda ◽  
K. Toyohara ◽  
G. Izumi ◽  
D. Takeuchi ◽  
M. Shoda ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Supraventricular Tachycardia ◽  
Total Cavopulmonary Connection ◽  
Cavopulmonary Connection

Total cavopulmonary connection with an extracardiac conduit: experience with 100 patients

2002 ◽  
Vol 73 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Shigehiko Tokunaga ◽  
Hideaki Kado ◽  
Yutaka Imoto ◽  
Munetaka Masuda ◽  
Yuichi Shiokawa ◽  
...  
Keyword(s):  
Total Cavopulmonary Connection ◽  
Extracardiac Conduit ◽  
Cavopulmonary Connection

Possible sources of right-to-left shunting in patients following a total cavopulmonary connection

1998 ◽  
Vol 8 (3) ◽  
pp. 358-363 ◽  
Author(s):  
Gernot Buheitel ◽  
Michael Hofbeck ◽  
Ursula Tenbrink ◽  
Georg Leipold ◽  
Jürgen v.d. Emde ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Arterial Oxygen Saturation ◽  
Pulmonary Veins ◽  
Arterial Oxygen ◽  
Total Cavopulmonary Connection ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Arteriovenous Fistulas ◽  
Cavopulmonary Connection

AbstractDespite a good haemodynamic result, many children have amildly decreased arterial oxygen saturation following a total cavopulmonary connection. Our study was performed to determine possible mechanisms of right-to-left shunting in these patients. We performed elective cardiac catheterization in 19 children at a mean interval of 3.6 years following a total cavopulmonary connection. The intrapulmonary right-to-left shunt, the intracardiac right-to-left shunt and the total right-to-left shunt were calculated under mechanical ventilation with 100% oxygen. The intrapulmonary right-to-left shunt was 10.8±3.5% of the pulmonary blood flow, and the total right-to left shunt accounted for 18.9±5.2% of the systemic blood flow. The intracardiac right-to-left shunt in patients with no relevant venovenous collaterals or leaks in the atrial tunnel was calculated at 6.4±3.0% of the systemic blood flow, while the intracardiac right-to-left shunt in patients with relevant collaterials or leaks accounted for 13.0±5.9% of the systemic blood flow. Since intrapulmonary arteriovenous fistulas were not demonstrated angiographically in any of our patients, the intrapulmonary right-to-left shunt is probably due to low ratios of perfusion to ventilation in some pulmonary segments. The intracafdiac right-to-left shunt was due to leaks across the interatrial baffle, collaterals between stystemic and pulmonary veins, and to the coronary sinus draining to the pulmonary venous atrium.

Total Cavopulmonary Connection with Off-Pump Technique

2005 ◽  
Vol 13 (3) ◽  
pp. 225-228 ◽  
Author(s):  
Jian-Ping Xu ◽  
Xin-Jin Luo ◽  
Jun-Ming Chu ◽  
Shou-Jun Li ◽  
Ying-Long Liu
Keyword(s):  
Cardiopulmonary Bypass ◽  
Oxygen Saturation ◽  
Early Postoperative Period ◽  
Univentricular Heart ◽  
Total Cavopulmonary Connection ◽  
Early Management ◽  
Off Pump ◽  
Extracardiac Conduit ◽  
Extubation Time ◽  
Cavopulmonary Connection

The aim of this study was to evaluate an off-pump technique for total cavopulmonary connection. Between May 2000 and June 2004, 16 patients underwent total cavopulmonary connection without cardiopulmonary bypass. There were 8 males and 8 females, with a mean age of 9.8 ± 6.2 years and a mean weight of 27.7 ± 14.9 kg. Preoperative percutaneous oxygen saturation was 75% ± 6%, and pulmonary arterial pressure was 12.6 ± 2.7 mm Hg. Postoperative outcomes were retrospectively compared with a group of 17 patients who underwent total cavopulmonary connection with an extracardiac conduit under cardiopulmonary bypass. Two patients died early postoperatively. Chylothorax occurred in 2 patients and 3 underwent reoperation for fenestration between the extracardiac conduit and the right atrium in the early postoperative period. All survivors were acyanotic. On discharge from hospital, the percutaneous oxygen saturation breathing air was 95% ± 3%. Patients in the off-pump group demonstrated significantly shorter extubation time and intensive care unit stay. This connection technique is easy to perform and helpful in the early management of patients with a functional univentricular heart. However, much remains to be learned about this unique physiologic system.

scholarly journals Extracardiac conduit in total cavopulmonary connection

2003 ◽  
Vol 18 (3) ◽  
Author(s):  
Paulo Paredes Paulista ◽  
Luiz Carlos Bento de Souza ◽  
Paulo Chaccur ◽  
Mário Issa ◽  
Antonio Flávio Sanches de Almeida ◽  
...  
Keyword(s):  
Total Cavopulmonary Connection ◽  
Extracardiac Conduit ◽  
Cavopulmonary Connection

scholarly journals Staged total cavopulmonary connection: serial comparison of intra-atrial lateral tunnel and extracardiac conduit taking account of current surgical adaptations

2019 ◽  
Vol 29 (3) ◽  
pp. 453-460 ◽  
Author(s):  
Eva van den Bosch ◽  
Sjoerd S M Bossers ◽  
Ad J J C Bogers ◽  
Daniëlle Robbers-Visser ◽  
Arie P J van Dijk ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Total Cavopulmonary Connection ◽  
Overall Survival Rate ◽  
Free Survival ◽  
Patient Demographics ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Cavopulmonary Connection

AbstractOBJECTIVESOur goals were to compare the outcome of the intra-atrial lateral tunnel (ILT) and the extracardiac conduit (ECC) techniques for staged total cavopulmonary connection (TCPC) and to compare the current modifications of the TCPC technique, i.e. the prosthetic ILT technique with the current ECC technique with a ≥18-mm conduit.METHODSWe included patients who had undergone a staged TCPC between 1988 and 2008. Records were reviewed for patient demographics, operative details and events during follow-up (death, surgical and catheter-based reinterventions and arrhythmias).RESULTSOf the 208 patients included, 103 had the ILT (51 baffle, 52 prosthetic) technique and 105 had the ECC technique. Median follow-up duration was 13.2 years (interquartile range 9.5–16.3). At 15 years after the TCPC, the overall survival rate was comparable (81% ILT vs 89% ECC; P = 0.12). Freedom from late surgical and catheter-based reintervention was higher for patients who had ILT than for those who had ECC (63% vs 44%; P = 0.016). However, freedom from late arrhythmia was lower for patients who had ILT than for those who had ECC (71% vs 85%, P = 0.034). In a subgroup of patients who had the current TCPC technique, when we compared the use of a prosthetic ILT with ≥18-mm ECC, we found no differences in freedom from late arrhythmias (82% vs 86%, P = 0.64) or in freedom from late reinterventions (70% vs 52%, P = 0.14).CONCLUSIONSA comparison between the updated prosthetic ILT and current ≥18-mm ECC techniques revealed no differences in late arrhythmia-free survival or late reintervention-free survival. Overall, outcomes after the staged TCPC were relatively good and reinterventions occurred more frequently in the ECC group, whereas late arrhythmias were more common in the ILT group.

scholarly journals Exercise capacity in children after total cavopulmonary connection: Lateral tunnel versus extracardiac conduit technique

2014 ◽  
Vol 148 (4) ◽  
pp. 1490-1497 ◽  
Author(s):  
Sjoerd S.M. Bossers ◽  
Willem A. Helbing ◽  
Nienke Duppen ◽  
Irene M. Kuipers ◽  
Michiel Schokking ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Total Cavopulmonary Connection ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Cavopulmonary Connection
Sign in / Sign up

Export Citation Format

Share Document