Hostname: page-component-848d4c4894-p2v8j Total loading time: 0 Render date: 2024-04-30T12:59:45.267Z Has data issue: false hasContentIssue false
  • English
  • Français

Fontan conversion with hepatic vein exclusion: a means for hepatic preservation in single ventricle heart disease

Published online by Cambridge University Press:  03 July 2015

Brian Kogon ,
Michael McConnell  and
Wendy Book
Brian Kogon*
Affiliation:
Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, United States of America
Michael McConnell
Affiliation:
Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
Wendy Book
Affiliation:
Department of Cardiology, Emory University, Atlanta, Georgia, United States of America
*
Correspondence to: B. E. Kogon, MD, Department of Pediatric Cardiothoracic Surgery, Children’s Healthcare of Atlanta, Emory University, Egleston 1405 Clifton Road NE Atlanta, Georgia, United States of America. Tel: +404 785 6319; Fax: +404 785 6265; E-mail: Bkogon@emory.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Patients with single ventricle heart disease often undergo staged surgical palliation, ultimately resulting in Fontan anatomy and physiology. Long-term consequences include cirrhosis of the liver, protein-losing enteropathy, and premature death. Elevated central venous pressure and venous congestion transmitted to the abdominal viscera have been implicated in the aetiology of many of these complications. We present a novel operation directed at protecting the liver and intestines by excluding the splanchnic venous return from the Fontan pathway. Instead of exposure to elevated Fontan pressures, the liver and intestines will be exposed to lower common atrial pressures. We hope that this modification will minimise the abdominal complications of Fontan anatomy and physiology.

Keywords

Single ventricleFontan conversionhepatic vein exclusion
Type
Brief Reports
Information
Cardiology in the Young , Volume 26 , Issue 3 , March 2016 , pp. 582 - 585
Check for updates
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Mahle, WT, Spray, TL, Wernovsky, G, Gaynor, JW, Clark, BJ. Survival after reconstructive surgery for hypoplastic left heart syndrome: a 15-year experience from a single institution. Circulation 2000; 10: III-136–III-141.Google Scholar
2. Lee, JR, Choi, JS, Kang, CH, Bae, EJ, Kim, YJ, Rho, JR. Surgical results of patients with a functional single ventricle. Eur J Cardiothorac Surg 2003; 24: 716–722.Google Scholar
3. de Laval, MR, Deanfield, JE. Four decades of Fontan palliation. Nat Rev Cardiol 2010; 7: 520–527.CrossRefGoogle Scholar
4. Moller, P, Weirz, M, Jensen, KO, et al. Exercise capacity of a contemporary cohort of children with hypoplastic left heart syndrome after staged palliation. Eur J Cardiothoracic Surg 2009; 36: 980–985.CrossRefGoogle ScholarPubMed
5. Mertens, L, Hagler, DJ, Sauer, U, Somerville, J, Gewillig, M. Protein-losing enteropathy after the Fontan operation: an international multicenter study. PLE study group. J Thorac Cardiovasc Surg 1998; 115: 1063–1073.CrossRefGoogle ScholarPubMed
6. Ghaferi, AA, Hutchins, GM. Progression of liver pathology in patients undergoing the Fontan procedure: chronic passive congestion, cardiac cirrhosis, hepatic adenoma, and hepatocellular carcinoma. J Thorac Cardiovasc Surg 2005; 129: 1348–1352.CrossRefGoogle ScholarPubMed
7. Reed, M, Leonard, S, Zellers, T, Nikaidoh, H. Major intrahepatic venovenous fistulas after a modified Fontan operation. Ann Thorac Surg 1996; 61: 713–715.Google Scholar
8. Schneider, D, Banerjee, A, Mendelsohn, A, Norwood, W. Hepatic venous malformation after modified Fontan procedure with partial hepatic vein exclusion. Ann Thorac Surg 1997; 63: 1177–1179.Google Scholar
9. Brizard, C, Goussef, N, Chachques, J, Carpentier, A. Model of complete separation of the hepatic veins from the systemic venous system. Ann Thorac Surg 2000; 70: 2096–2101.Google Scholar
10. Garg, P, Talwar, S, Kothari, S, Rajashekar, P, Saxena, R, Airan, B. Role of systemic to pulmonary shunt after cavopulmonary anastomosis. J Card Surg 2013; 28: 599–603.Google Scholar