Right-to-left shunt through the cardiac veins after the Fontan procedure

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Vascular Biology

Background:

• The Fontan procedure is a palliative surgery for complex congenital heart disease.
• Postoperative complications require careful monitoring and understanding of cardiac venous anatomy.

Observation:

• Two patients exhibited unusual postoperative findings following the Fontan procedure.
• These findings involved abnormal vascular connections within the cardiac venous system.

Findings:

• Right-to-left shunts were identified through the cardiac veins in both patients.
• In one case, channels existed independent of the coronary sinus.
• The second patient presented with an atretic coronary sinus orifice and a persistent left superior vena cava.

Implications:

• These findings highlight potential venous complications after Fontan surgery.
• Understanding these anomalies is crucial for managing postoperative outcomes.
• Further research into venous anomalies post-Fontan may improve surgical strategies.