Modified Fontan without use of cardiopulmonary bypass

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Presentation transcript:

Modified Fontan without use of cardiopulmonary bypass Vincent K.H Tam, MD, Bruce E Miller, MD, Kathy Murphy The Annals of Thoracic Surgery Volume 68, Issue 5, Pages 1698-1703 (November 1999) DOI: 10.1016/S0003-4975(99)01067-X

Fig 1 Right branch pulmonary artery has been isolated and a longitudinal arteriotomy made. A vascular clamp is used to direct superior vena cava blood flow to the left lung only. The Annals of Thoracic Surgery 1999 68, 1698-1703DOI: (10.1016/S0003-4975(99)01067-X)

Fig 2 The extracardiac conduit to pulmonary artery anastomosis has been completed. Superior vena cava blood flow is now reestablished to both right and left lungs. An inferior vena cava to right atrial shunt has been placed. The Annals of Thoracic Surgery 1999 68, 1698-1703DOI: (10.1016/S0003-4975(99)01067-X)

Fig 3 The inferior vena cava is divided from the right atrium and the cardiac end oversewn. The inferior vena cava to the right atrial shunt allows venous blood to continue to return to the right atrium. The Annals of Thoracic Surgery 1999 68, 1698-1703DOI: (10.1016/S0003-4975(99)01067-X)

Fig 4 The inferior vena cava to extracardiac conduit anastomosis is performed. The Annals of Thoracic Surgery 1999 68, 1698-1703DOI: (10.1016/S0003-4975(99)01067-X)

Fig 5 Completion Fontan using an extracardiac conduit has been accomplished without the use of cardiopulmonary bypass. A fenestration may be placed between the extracardiac conduit and the atrium. The Annals of Thoracic Surgery 1999 68, 1698-1703DOI: (10.1016/S0003-4975(99)01067-X)

Fig 6 Angiogram demonstrating direct inferior vena cava to main pulmonary artery connection, accomplished without the use of cardiopulmonary bypass. Because of the slight rotation of the patient, the branch pulmonary artery confluence is superimposed on the Glenn anastomosis, which had been placed in the very distal right branch pulmonary artery. The Annals of Thoracic Surgery 1999 68, 1698-1703DOI: (10.1016/S0003-4975(99)01067-X)

Fig 7 Pulmonary venous atrial pressures at the end of surgery, 6, 12, and 24 hours postoperatively. ∗ p < 0.05. The Annals of Thoracic Surgery 1999 68, 1698-1703DOI: (10.1016/S0003-4975(99)01067-X)

Fig 8 Optimal growth and development of the right and left branch pulmonary arteries in an infant 5 months after the Norwood operation for hypoplastic left heart syndrome. The Annals of Thoracic Surgery 1999 68, 1698-1703DOI: (10.1016/S0003-4975(99)01067-X)

Fig 9 Construction of the Glenn anastomosis toward the left branch pulmonary artery in the same patient with hypoplastic left heart syndrome. The Annals of Thoracic Surgery 1999 68, 1698-1703DOI: (10.1016/S0003-4975(99)01067-X)