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Total cavopulmonary connection via a thoracotomy.
Miwa Nanaumi1, Toshihide Asou, Yuko Takeda
1Department of Thoracic and Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
The Annals of Thoracic Surgery
|September 20, 2002
Summary
A right thoracotomy approach for total cavopulmonary connection avoided sternal reentry complications in a patient with prior mediastinitis. This surgical technique offers a safer alternative for staged Fontan completion in complex cases.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Congenital heart defects often require staged surgical palliation, such as the Fontan procedure.
- Previous mediastinitis poses significant risks for sternal reentry during subsequent cardiac surgeries.
- Extracardiac conduits are used in total cavopulmonary connection to bypass the heart.
Observation:
- A patient with a history of mediastinitis required completion of a staged Fontan procedure.
- A right thoracotomy approach was utilized for the total cavopulmonary connection with an extracardiac conduit.
Findings:
- The thoracotomy approach successfully facilitated the extracardiac conduit placement.
- This surgical strategy circumvented the need for sternal reentry, mitigating risks associated with prior mediastinitis.
Implications:
- A right thoracotomy is a viable alternative for total cavopulmonary connection in patients with mediastinitis.
- This approach enhances patient safety by avoiding hazardous sternal reentry complications.
- It expands surgical options for complex Fontan pathway completion.