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Fontan completion in reverse order out of necessity: secondary Glenn after primary extracardiac inferior cavopulmonary artery connection

  • Jannika Dodge-Khatami (a1), Avichal Aggarwal (a2), Mary B. Taylor (a2) (a3), Douglas Maposa (a4), Jorge D. Salazar (a5) and Ali Dodge-Khatami (a5)...

Abstract

The primary extracardiac inferior cavopulmonary connection is an unusual novel palliation for single-ventricle physiology, which we first performed in the setting of unfavourable upper-body systemic venous anatomy for a standard bi-directional Glenn, and in lieu of leaving our patient with shunt-dependent physiology. After an initial 16-month satisfactory follow-up, increasing cyanosis led to the discovery of a veno-venous collateral that was coiled, but, more importantly, to impressive growth of a previously diminutive superior caval vein, which allowed us to perform completion Fontan with a good outcome. Performing the single-ventricle staging in a reverse manner, first from below with a primary inferior cavopulmonary connection, followed by Fontan completion from above with a standard superior caval vein bi-directional Glenn, is also possible when deemed necessary.

Copyright

Corresponding author

Correspondence to: A. Dodge-Khatami, MD, PhD, Chief, Pediatric and Congenital Heart Surgery, Children’s Heart Center, University of Mississippi Medical Center, 2500 North State Street, Room S345, Jackson, MS 39216, United States of America. Tel: +1 601 984 4693; Fax: +1 601 984 5872; E-mail: adodgekhatami@umc.edu

References

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1. Dodge-Khatami, A, Aggarwal, A, Taylor, MB, Maposa, D, Salazar, JD. When the bidirectional Glenn is an unfavorable option: inferior cavopulmonary connection as an alternative palliation. Cardiol Young 2015; 28: 13.
2. Dodge-Khatami, A, Salazar, JD. When the bidirectional Glenn is an unfavorable option: inferior cavopulmonary connection as an alternative palliation. Surgical motion picture published on CTSNet, February 8, 2016.
3. Bridges, ND, Jonas, RA, Mayer, JE, Flanagan, MF, Keane, JF, Castaneda, AR. Bidirectional cavopulmonary anastomosis as interim palliation for high-risk Fontan candidates. Early results. Circulation 1990; 82 (Suppl): IV170IV176.
4. Pridjian, AK, Mendelsohn, AM, Lupinetti, FM, et al. Usefulness of the bidirectional Glenn procedure as staged reconstruction for the functional single ventricle. Am J Cardiol 1993; 71: 959962.
5. Jacobs, ML, Norwood, WI Jr. Fontan operation: influence of modifications on morbidity and mortality. Ann Thorac Surg 1994; 58: 945951; discussion 951–952.
6. Glenn, WW, Patino, JF. Circulatory by-pass of the right heart. I. Preliminary observations on the direct delivery of vena caval blood into the pulmonary arterial circulation; azygos vein-pulmonary artery shunt. Yale J Biol Med 1954; 27: 147151.
7. Glenn, WW. Circulatory bypass of the right side of the heart. IV. Shunt between superior vena cava and distal right pulmonary artery; report of clinical application. N Engl J Med 1958; 259: 117120.

Keywords

Fontan completion in reverse order out of necessity: secondary Glenn after primary extracardiac inferior cavopulmonary artery connection

  • Jannika Dodge-Khatami (a1), Avichal Aggarwal (a2), Mary B. Taylor (a2) (a3), Douglas Maposa (a4), Jorge D. Salazar (a5) and Ali Dodge-Khatami (a5)...

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