Complete Thrombosis of the Conduit and Inferior Vena-cava Early After Extracardiac Fontan Operation

We report the case of a six-year-old patient who underwent an extracardiac Fontan operation including bilateral bidirectional superior cavopulmonary anastomosis and direct inferior vena cava to main pulmonary artery connection that was performed without cardiopulmonary bypass.

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Severity of hepatic fibrosis after Fontan operation is associated with early post-operative inferior vena cava pressure and time from surgery

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(17)30908-4 ◽

2017 ◽

Vol 9 (4) ◽

pp. 278

Author(s):

Bruno Lefort ◽

Anaïs Jaillais ◽

Blandine Aupy ◽

Fanny Dion ◽

Nathalie Soulé ◽

...

Keyword(s):

Inferior Vena Cava ◽

Hepatic Fibrosis ◽

Inferior Vena ◽

Fontan Operation ◽

Vena Cava ◽

Inferior Vena Cava Pressure

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Modified total cavopulmonary shunt as a staged Fontan operation

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492317692466 ◽

2017 ◽

Vol 26 (9) ◽

pp. 701-703

Author(s):

Hidetsugu Asai ◽

Tsuyoshi Tachibana ◽

Yasushige Shingu ◽

Hiroki Kato ◽

Satoru Wakasa ◽

...

Keyword(s):

Inferior Vena Cava ◽

Right Ventricular ◽

Superior Vena Cava ◽

Inferior Vena ◽

Superior Vena ◽

Fontan Operation ◽

Vena Cava ◽

Left Superior Vena Cava ◽

The Right ◽

Cavopulmonary Shunt

The left superior vena cava became occluded in an infant with hypoplastic left heart syndrome. After a bidirectional Glenn procedure, he presented with severe oxygen desaturation and right ventricular dysfunction; the left superior vena cava drained into the inferior vena cava through collateral veins. As salvage therapy, we created a modified total cavopulmonary shunt using only autologous tissue in which the right hepatic vein and inferior vena cava drained into the pulmonary artery via a lateral tunnel in the right atrium. Immediately after surgery, his oxygen saturation increased and right ventricular function improved.

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Hepatic Vein Incorporation Into the Azygos System in Heterotaxy and Interrupted Inferior Vena Cava

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119842869 ◽

2019 ◽

Vol 10 (3) ◽

pp. 330-337

Author(s):

Christine Montesa ◽

Tara Karamlou ◽

Kanishka Ratnayaka ◽

Stephen G. Pophal ◽

Justin Ryan ◽

...

Keyword(s):

Inferior Vena Cava ◽

Hepatic Vein ◽

Inferior Vena ◽

Fontan Operation ◽

Vena Cava ◽

Hepatic Veins ◽

Extracardiac Conduit ◽

Complex Patients ◽

Surgeon Experience

Background: Patients with heterotaxy, single ventricle and interrupted inferior vena cava are at risk of developing significant pulmonary arteriovenous malformations and cyanosis, and inequitable distribution of hepatic factor has been implicated in their development. We describe our experience with a technique for hepatic vein incorporation that reliably provides resolution of cyanosis and presumably equitable hepatic factor distribution. Methods: A retrospective review of a single-surgeon experience was conducted for patients who underwent this modified Fontan operation utilizing an extracardiac conduit from the hepatic veins to the dominant superior cavopulmonary connection. Preoperative characteristics and imaging, operative details, and postoperative course and imaging were abstracted. Results: Median age at operation was 5 years (2-10 years) and median weight was 19.6 kg (11.8-23 kg). Sixty percent (3/5) of patients had Fontan completion without cardiopulmonary bypass, and follow-up was complete at a median of 14 months (range 1-20 months). Systemic saturations increased significantly from 81% ± 1.9% preoperatively to 95% ± 3.5% postoperatively, P = .0008. Median length of stay was 10 days (range: 7-14 days). No deaths occurred. One patient required reoperation for bleeding and one was readmitted for pleural effusion. Postoperative imaging suggested distribution of hepatic factor to all lung segments with improved pulmonary arteriovenous malformation burden. Conclusions: Hepatic vein incorporation for patients with heterotaxy and interrupted inferior vena cava should optimally provide equitable pulmonary distribution of hepatic factor with resolution of cyanosis. The described technique is performed through a conventional approach, is facile, and improves cyanosis in these complex patients.

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Aortic Arch Homograft Reconstruction of Nonconfluent Pulmonary Arteries During Extracardiac Fontan

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118775383 ◽

2018 ◽

Vol 9 (5) ◽

pp. 582-584

Author(s):

Koichi Sughimoto ◽

Shubhayan Sanatani ◽

Sanjiv K. Gandhi

Keyword(s):

Case Report ◽

Pulmonary Artery ◽

Inferior Vena Cava ◽

Aortic Arch ◽

Inferior Vena ◽

Pulmonary Arteries ◽

Vena Cava ◽

Technical Issue ◽

Aortic Homograft ◽

Extracardiac Fontan

Reconstruction of nonconfluent pulmonary arteries during Fontan completion is a challenging technical issue. In this case report, we describe the use of an aortic homograft, including the aortic arch, to complete a Fontan and reconstruct the pulmonary artery confluence in a child with discontinuous pulmonary arteries and bilateral superior caval veins who had undergone bilateral unidirectional Glenn palliation. The configuration of the aortic homograft was ideal to ensure laminar flow from the inferior vena cava to both pulmonary arteries and in maintaining durable elastance posterior to the native aorta.

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