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Formation of thrombus in the residual pulmonary trunk and regurgitation of the pulmonary valve after total cavopulmonary connection

Published online by Cambridge University Press:  19 August 2008

Michael Hofbeck ,
Helmut Singer ,
Gernot Buheitel ,
Jan Sunnegardh  and
Jürgen V.D. Emde
Michael Hofbeck*
Affiliation:
Department of Pediatric Cardiology and Department of Cardiovascular SurgeryUniversity Erlangen-NümbergFederal Republic of Germany
Helmut Singer
Affiliation:
Department of Pediatric Cardiology and Department of Cardiovascular SurgeryUniversity Erlangen-NümbergFederal Republic of Germany
Gernot Buheitel
Affiliation:
Department of Pediatric Cardiology and Department of Cardiovascular SurgeryUniversity Erlangen-NümbergFederal Republic of Germany
Jan Sunnegardh
Affiliation:
Department of Pediatric Cardiology and Department of Cardiovascular SurgeryUniversity Erlangen-NümbergFederal Republic of Germany
Jürgen V.D. Emde
Affiliation:
Department of Pediatric Cardiology and Department of Cardiovascular SurgeryUniversity Erlangen-NümbergFederal Republic of Germany
*
Priv. Doz. Dr. M. Hofbeck Univ. Kinderklinik Loschgestr, 15 D-91054 ErlangenGermany. Tel: 9131-853750, Fax: 9131-853113
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Abstract

The procedure of total cavopulmonary connexion includes trans-section and closure of the pulmonary trunk, the systemic venous blood flow being directed to the pulmonary vascular bed by an anastomosis of the superior caval vein with the right pulmonary artery. Following this procedure, there remains a small residual pulmonary trunk. The purpose of our study was to obtain information about the fate of this residual trunk and its contained pulmonary valve. Using transthoracic echocardiography, we examined 29 patients (mean age 7 years 4 months) after a total cavopulmonary connexion (mean interval 17 months). We were able to obtain adequate visualization of the pulmonary valve and the pulmonary trunk in 23 of the patients. Pulmonary regurgitation was demonstrated by colour Doppler echocardiography in 13 pts (57%). Formation of thrombus in the residual pulmonary trunk was detected in one patient (4%) 6 months after the operation. One cerebrovascular embolic event occurred in a patient who had pulmonary regurgitation without formation of thrombus in the residual trunk 3 months after the total cavopulmonary connexion. Our findings show that pulmonary regurgitation is frequently present in patients after total cavopulmonary connexion. Although formation of thrombus in the residual pulmonary trunk seems to be less common, we recommend surgical closure of the pulmonary valve during this procedure so as to exclude the residual pulmonary trunk as a possible source of systemic emboli.

Keywords

Fontah operationtotal cavopulmonary connectioncongenital heart diseasethrombosispulmonary regurgitation
Type
Original Articles
Information
Cardiology in the Young , Volume 7 , Issue 1 , January 1997 , pp. 44 - 49
Copyright
Copyright © Cambridge University Press 1997

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References

1.Balaji, S, Gewillig, M, Bull, C, de Leval, MR, Deanfield, J. Arrhythmias after the Fontan procedure. Comparison of total cavopulmonary connection and atriopulmonary connection. Circulation 1991; 84(suppl III): III-162–III-167.Google ScholarPubMed
2.Bridges, ND, Mayer, JE, Lock, JE, Jonas, RA, Hanley, FL, Keane, JF, Perry, SB, Castaneda, AR. Effect of baffle fenestration on outcome of the modified Fontan operation. Circulation 1992; 86: 1762–1769.CrossRefGoogle ScholarPubMed
3.Pearl, JM, Laks, H, Stein, DG, Drinkwater, DC, George, BL, Williams, RG. Total cavopulmonary anastomosis versus conventional modified Fontan procedure. Ann Thorac Surg 1991; 52: 189–196CrossRefGoogle ScholarPubMed
4.Puga, FJ, Chiavarelli, M, Hagler, DJ.Modifications of the Fontan operation applicable to patients with left atrioventricular valve atresia or single atrioventricular valve.Circulation 1987: 76(suppl III): III-53–III-6O.Google ScholarPubMed
5.Hofbeck, M, Singer, H, Scharf, J, Wild, F, Ries, M, Mahmoud, O, Blum, U, vd Emde, J. Total cavopulmonary anastomosis: Selection criteria related to postoperative results. Thoraccardiovasc Surgeon 1993; 41: 28–33.Google ScholarPubMed
6.De Leval, MR, Kilner, P, Gewillig, M, Bull, C. Total cavopulmonary connection: A logical alternative to atriopulmonary connection for complex Fontan operations. J Thorac Cardiovasc Surg 1988; 96:682–695.CrossRefGoogle ScholarPubMed
7.De Leval, M. Right heart bypass operations. In: Stark, J, De Leval, M, edts. Surgery for congenital heart defects. WB Saunders Company, Philadelphia London, 1993: 565–585.Google Scholar
8.Yoshida, K, Yoshikawa, J, Shakudo, M, Akasaka, T, Jyo, Y, Takao, S, Shiratori, K, Koizumi, K, Okumachi, F, Kato, H, Fukaya, T. Color Doppler evaluation of valvular regurgitation in normal subjects. Circulation 1988; 78: 840–847.CrossRefGoogle ScholarPubMed
9.Sahn, DJ, Maciel, BC. Physiological valvular regurgitation. Doppler echocardiography and the potential for iatrogenic heart disease. Circulation 1988; 78: 1075–1077.CrossRefGoogle ScholarPubMed
10.Stümper, O, Sutherland, GR, Geuskens, R, Roelandt, JRTC, Bos, E, Hess, J. Transesophageal echocardiography in evaluation and management after a Fontan procedure. J Am Coll Cardiol 1991; 17: 1152–1160CrossRefGoogle ScholarPubMed
11.Rosenthal, DN, Friedman, AH, Kleinman, CS, Kopf, GS, Rosenfeld, LE, Hellenbrand, WE. Thromboembolic complications following Fontan procedures (abstr). Circulation 1994; 90(supplI): 1–96.Google Scholar