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Heart transplantation after Fontan's procedure with bilateral cavopulmonary connections
T D T Tjan1, H H Scheld, C Schmid
1Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Muenster, Germany. st.d.t.tjan@ukmuenster.de
Insights
This case study details a heart transplant for a young female with complex congenital heart disease, utilizing a novel approach for superior vena cava reconstruction. The persistent left superior caval vein was successfully reanastomosed into the right atrium.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pediatric Cardiology
Background:
- Complete Fontan procedure and bidirectional cavopulmonary connections present complex surgical challenges.
- Congenital heart defects often require staged surgical palliation and may necessitate heart transplantation.
Observation:
- A young female patient with three caval drainages post-Fontan procedure and bilateral bidirectional cavopulmonary connections was evaluated for orthotopic heart transplantation.
- Hypoplastic innominate vein posed a reconstruction challenge during the transplant procedure.
Findings:
- The persistent left superior caval vein was successfully reanastomosed into the recipient's right atrium via the coronary sinus.
- This technique avoided reconstruction of the hypoplastic innominate vein, offering an alternative surgical strategy.
Implications:
- This case demonstrates a feasible alternative surgical technique for managing complex venous anomalies during heart transplantation in Fontan patients.
- The described approach may improve outcomes for select pediatric heart transplant recipients with challenging venous anatomy.
Abstract:
We present a young female patient with three caval drainages after complete Fontan's procedure and with bilateral bidirectional cavopulmonary connections who underwent orthotopic heart transplantation. Instead of reconstructing the hypoplastic innominate vein the persistent left superior caval vein was reanastomosed via the recipient's coronary sinus into the right atrium.
