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Severe coronary sinus dilatation after a modification of the classic Fontan operation: successful resolution with a

A L Mock1, C D Fraser, W J Dreyer

  • 1Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA.

Pediatric Cardiology
|November 25, 2003
PubMed

Insights

Two patients with single ventricle and left superior vena cava experienced severe dilation after Fontan modification. Revision surgery improved their functional capacity, offering a potential solution for complex congenital heart disease.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Functional single ventricle physiology presents unique surgical challenges.
  • The Fontan procedure is a palliative treatment for complex single-ventricle defects.
  • Anatomic variations like left superior vena cava require specific surgical considerations.

Observation:

  • Two patients with single ventricle and left superior vena cava (LSVC) underwent Fontan modification incorporating the coronary sinus.
  • Both patients developed significant right atrial and coronary sinus dilation post-Fontan.
  • This dilation suggests potential complications related to altered venous drainage pathways.

Findings:

  • Revision of the Fontan pathway using an intraatrial lateral tunnel and extracardiac conduit was performed.
  • Post-revision, both patients demonstrated improved functional capacity.
  • The surgical revision effectively addressed the complications arising from the initial Fontan modification.

Implications:

  • Intraatrial lateral tunnel and extracardiac conduit revisions may be effective for managing Fontan-associated complications.
  • Understanding venous drainage patterns in single-ventricle physiology is crucial for surgical planning.
  • Further research is needed to optimize Fontan pathway modifications in patients with complex venous anomalies.

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