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[A case report of total cavopulmonary connection following total cavopulmonary shunt]
Y Shiina1, M Mukaida, K Ishibashi
1Third Department of Surgery, Iwate Medical University, Morioka, Japan.
Insights
This study presents a novel surgical approach for complex congenital heart disease. A left thoracotomy allowed successful redo total cavopulmonary connection in a patient with prior adhesions.
Area of Science:
- Cardiovascular Surgery
- Congenital Heart Disease
- Pediatric Cardiology
Background:
- A 20-year-old male with univentricular heart type A (A.L.L.) underwent a total cavopulmonary shunt with hemiazygos connection.
- Six years post-surgery, the patient experienced symptom recurrence including fatigue and cyanosis, indicating shunt failure.
Observation:
- Cardiac catheterization revealed recanalization of the previously ligated superior vena cava (SVC).
- Chest CT imaging demonstrated significant adhesions between the chest wall and the ascending aorta, complicating re-operation.
Findings:
- A redo total cavopulmonary connection was successfully performed using a left anterolateral thoracotomy approach.
- This technique avoided injury to the ascending aorta and ventricle, crucial given the adhesions.
- The procedure utilized circulatory arrest and retrograde cardioplegia without aortic cross-clamping.
Implications:
- Left anterolateral thoracotomy is a viable and safe alternative for redo total cavopulmonary connection in complex cases with adhesions.
- This approach minimizes risks associated with re-sternotomy in patients with significant mediastinal adhesions.
- Successful re-intervention offers improved outcomes for patients with Fontan-associated complications.
Abstract:
A 20-year-old man underwent total cavopulmonary shunt for univentricular heart type A (A.L.L.) with hemiazygos connection six years ago. Four years later, his condition deteriorated with easy fatigue and cyanosis. Cardiac catheterization showed recanalization of ligated SVC. Chest CT showed tight adhesion between the chest wall and the ascending aorta. We approached the heart through left anterolateral thoracotomy in order to avoid injury of the aorta and the ventricle during redo median sternotomy. Total cavopulmonary connection with intraatrial conduit was performed under circulatory arrest and retrograde cardioplegia without aortic cross clamp. His postoperative course was satisfactory. Left thoracotomy was useful for total cavopulmonary connection following total cavopulmonary shunt associated with postoperative adhesion.