Case Report: Extracorporeal Membrane Oxygenation In Curing A Young Man Post-Operative of The Modified Fontan Operation

Background: The Fontan operation is the only treatment option to change the anatomy of the heart and help improve patients’ hemodynamics. After successful operation, patients typically recover the ability to engage in general physical activity. The mortality of patients diagnosed with acute respiratory distress syndrome (ARDS) ranges from 17.3 to 41.4% among critically ill patients with H1N1 infection. As a better ventilatory strategy, extracorporeal membrane oxygenation (ECMO) provides gas exchange via an extracorporeal circuit, and is increasingly being used to improve respiratory and circulatory function. As is known to all, after the modified Fontan operation, circulation was different compared with patients who were not subjected to the procedure. But very few articles describe the special circulation about the case who was post-operative of the modified Fontan operation especially when it received the treatment of E-CMO. This study aims to describe a successful case using E-CMO in curing the influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation thirteen years ago. We want to explore the special cardiac structure and circulatory characteristics in this case.Methods: To report a successful case using extracorporeal membrane oxygenation in curing the influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation thirteen years ago. In this article, we describe a 23-year-old man, with a history of modified Fontan operation for the Tausing-Bing syndrome, admitted to ICU with severe acute respiratory distress syndrome as a result of influenza A infection. The man was initially treated by V-V ECMO, five days later was switched to V-V-A E-CMO. Results: As circulation and respiratory function gradually improved, the VV-A ECMO equipment was removed on May 1, 2018.The patient was successfully withdrawn from artificial ventilation on May 28, 2018, then discharged from hospital on May 30, 2018.Conclusion: After the modified Fontan operation, circulation was different compared with patients who were not subjected to the procedure. There were certainly many differences between the two sides when they received the treatment of E-CMO. As the special cardiac structure and circulatory characteristics, an individualized liquid management strategy was necessary and it might be better for them to choose an active cycle support earlier.

Fontan Operation for Patients With Complex Anatomy: The Intra-Atrial Conduit Technique

The extracardiac conduit type of total cavopulmonary connection (TCPC) is the most common variation of the modified Fontan operation in current use. For patients with some forms of complex anatomy (eg, dextrocardia in situs solitus or asplenia syndrome), we have adopted a different technique: interposition of an intra-atrial conduit between the inferior vena cava (IVC) and the superior vena cava–right pulmonary artery (SVC-RPA) connection. We report our experience with six patients.