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[A case of modified Fontan procedure for SLL single ventricular heart with bicaval total occlusion]
S Yokoyama1, Y Takeuchi, A Gomi
1Department of Cardiovascular Surgery, Kanto Teishin Hospital, Tokyo, Japan.
Insights
This case study details a modified Fontan procedure for single ventricle heart disease. Despite complications like pneumonia and venous occlusion, the patient recovered well, highlighting the importance of specific surgical techniques and anticoagulation.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Physiology
Background:
- Single ventricle heart (SLL) presents complex surgical challenges.
- The Fontan procedure and bidirectional Glenn shunt are critical palliative surgeries.
- Anatomical variations like bilateral superior vena cava (SVC) require tailored surgical approaches.
Observation:
- A 6-year-old boy with single ventricle heart underwent a modified Fontan procedure and bidirectional Glenn shunt.
- The patient experienced severe postoperative pneumonia requiring prolonged intravenous catheterization.
- Postoperative angiography identified bicaval total occlusion.
Findings:
- Despite significant complications, the patient demonstrated a positive recovery.
- The study suggests anastomosing a left superior vena cava (LSVC) to the pulmonary artery (PA) in cases with bilateral SVC without communication.
- The bidirectional Glenn shunt proved vital in managing systemic venous route occlusion.
Implications:
- This approach may improve outcomes for single ventricle patients with specific venous anomalies.
- Anticoagulation therapy is crucial for patients undergoing Fontan-type procedures.
- Surgical modifications can enhance the safety and efficacy of palliative cardiac surgeries.
Abstract:
We successfully performed a modified Fontan procedure and bidirectional Glenn shunt for a 6-year-old boy with single ventricular heart (SLL). After the operation, the patient suffered from a severe pneumonia, so intravenous catheter had to be inserted for a long time. Post operative angiography revealed bicaval total occlusion. But, inspite of these several complications, this patient is doing well. We believe that if bilateral SVC without communication exist on such a candidate for the Fontan type procedure, LSVC should be anastomosed to PA. The bidirectional Glenn shunt will contribute to save a life of the patient when the systemic venous route was occluded. In addition, the anticoagulation therapy should be taken for the patients underwent the Fontan type procedure.