New transplant technique with hemiazygos continuation and interrupted inferior vena cava

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Transplantation Immunology

Background:

• Persistent left superior vena cava (PLSVC) poses a risk of venous obstruction during cardiac transplantation.
• Patients with hemiazygos continuation and interrupted inferior vena cava rely critically on PLSVC patency.
• Previous surgical strategies may not adequately address venous return challenges in these specific anatomies.

Observation:

• A novel surgical technique was developed utilizing a Fontan connection with the native central pulmonary artery for systemic venous return.
• The pulmonary artery anastomosis was strategically performed distal to the superior vena cava anastomosis sites.
• This approach was successfully applied in two pediatric patients experiencing severe heart failure post-Fontan completion.

Findings:

• The introduced surgical technique effectively managed systemic venous return in cardiac transplantation with PLSVC.
• Successful cardiac transplantation was achieved in two patients with complex venous anomalies and heart failure.
• The technique ensured the patency of the left superior vena cava, preventing flow obstruction.

Implications:

• This innovative surgical approach offers a viable solution for cardiac transplantation in patients with challenging venous anatomy.
• It highlights the potential of modified Fontan principles in complex congenital heart disease and transplantation scenarios.
• Further research may explore the long-term outcomes and broader applicability of this technique in similar patient populations.