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Extracardiac Fontan Operation Through a Right Thoracotomy

Suvro S Sett1, Rocco J Lafaro2

  • 1Department of Surgery, Section of Pediatric Cardiac Surgery, The Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, New York.

The Annals of Thoracic Surgery
|July 24, 2017
PubMed

Insights

An extracardiac Fontan operation via right thoracotomy offers a viable surgical option for complex pediatric heart conditions. This approach is particularly useful when the ascending aorta is near the sternum or following mediastinitis.

Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Disease
  • Thoracic Surgery

Background:

  • The Fontan operation is a palliative procedure for single-ventricle physiology.
  • Standard extracardiac Fontan procedures typically involve a median sternotomy.
  • Certain pediatric cardiac conditions necessitate alternative surgical approaches.

Observation:

  • An extracardiac Fontan operation can be performed through a right thoracotomy incision.
  • This approach is indicated in cases with ascending aorta proximity to the sternum (e.g., aortic atresia, transposed great vessels).
  • It is also a suitable alternative for patients with a history of mediastinitis.

Findings:

  • Right thoracotomy provides an alternative surgical access for extracardiac Fontan completion.
  • This method avoids sternal manipulation, which is beneficial in specific anatomical or post-inflammatory scenarios.

Implications:

  • This surgical technique expands treatment options for complex congenital heart defects.
  • It may reduce operative risks associated with sternal entry in select pediatric populations.
  • Facilitates Fontan completion in challenging anatomical configurations and post-sternotomy patients.

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