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Related Experiment Videos

Total extracardiac right heart bypass.

S Giannico1, A Corno, B Marino

  • 1Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Bambino Gesù, Rome, Italy.

Circulation
|November 1, 1992
PubMed
Summary
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This study on total extracardiac Fontan operations shows promising hemodynamic results and technical advantages. Early outcomes suggest a potential reduction in late atrial arrhythmias after single ventricle repair.

Area of Science:

  • Congenital Heart Surgery
  • Pediatric Cardiology
  • Cardiovascular Hemodynamics

Background:

  • Total cavopulmonary connection offers a rational alternative to atriopulmonary connection for complex Fontan operations.
  • Extracardiac Fontan procedures may mitigate late atrial arrhythmias post-single ventricle repair.
  • This study investigates hemodynamic findings in patients undergoing total extracardiac right heart bypass.

Purpose of the Study:

  • To document postoperative hemodynamic findings in patients with complex congenital heart disease undergoing total extracardiac right heart bypass.
  • To evaluate the efficacy of an inferior vena cava-to-pulmonary artery extracardiac Dacron conduit with a modified Glenn anastomosis.
  • To assess early outcomes, including hemodynamic parameters and arrhythmias.

Main Methods:

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  • Twenty-eight patients with complex congenital heart disease underwent total extracardiac right heart bypass with a modified Glenn anastomosis.
  • Postoperative hemodynamic assessment included cardiac catheterization and echo Doppler studies in 22 survivors.
  • Follow-up averaged 13.9 months.

Main Results:

  • Hemodynamic data were satisfactory in 18 of 22 assessed patients, with observed preferential caval flow to both lungs.
  • Echo Doppler revealed forward cavopulmonary flow as a predominant early diastolic event, suggesting a role for diastolic ventricular function.
  • Two survivors experienced early postoperative atrial arrhythmias.

Conclusions:

  • The total extracardiac right heart bypass demonstrates encouraging technical advantages and hemodynamic benefits.
  • No thromboembolic complications or conduit obstructions were observed in survivors despite extensive use of artificial material.
  • Longer follow-up is necessary to confirm early results, particularly the potential reduction in late atrial arrhythmias.