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Extracardiac Fontan operation without cardiopulmonary bypass
R P Burke1, J P Jacobs, M H Ashraf
1Division of Cardiovascular Surgery, Miami Children's Hospital, Florida 33155-4069, USA.
The Annals of Thoracic Surgery
|April 1, 1997
Summary
Chorea-athetosis developed in a child with a univentricular heart after a bidirectional cavopulmonary anastomosis. The Fontan operation was completed without cardiopulmonary bypass to manage this neurological issue.
Area of Science:
- Pediatric Cardiology
- Neurology
- Congenital Heart Disease
Background:
- Univentricular heart physiology presents complex surgical challenges.
- Bidirectional cavopulmonary anastomosis is a staged surgical palliation.
- Neurological complications can arise after cardiac surgery in neonates and infants.
Observation:
- A 17-month-old boy with univentricular heart developed choreoathetosis post-bidirectional cavopulmonary anastomosis.
- This neurological complication prompted a modified surgical approach for subsequent palliation.
Findings:
- The Fontan operation was successfully completed without cardiopulmonary bypass to mitigate neurological worsening.
- A left cavopulmonary anastomosis was maintained for pulmonary blood flow.
- Surgical reconstruction involved a tube graft to the right cavopulmonary anastomosis and a femoral vein-to-right atrial shunt.
Implications:
- This case highlights the potential for neurological sequelae after cavopulmonary anastomosis.
- Performing the Fontan completion without cardiopulmonary bypass may be a viable strategy in select cases with neurological concerns.
- Further research into neuroprotection strategies during staged palliation for univentricular heart is warranted.