Negative resultsA 25-year-old male patient was operated on for Tetralogy of Fallot in our hospital. Preoperatively, he was polycythemic. Echocardiography revealed the presence of left superior vena cava (SVC) and suggested the possibility of a coronary artery anomaly. Angiography revealed no coronary artery abnormality. The angiography also confirmed the presence of left SVC. The left SVC was filling from right SVC (via a bridging vein), left vertebral vein, left subclavian vein and left internal jugular vein (IJV). A 16-gauge cannula was inserted in the left hand for infusion of fluids and drugs. Anaesthesia was induced with a standard technique. A triple lumen cannula was inserted in the right IJV after induction of anaesthesia. After sternotomy, a small bridging vein connecting the left SVC and the right SVC was seen. Intraoperatively, heparin was given according to standard protocol and the activated clotting time was maintained at more than 480 s. Aprotinin was added to the prime. Venous drainage for cardiopulmonary bypass (CPB) was accomplished using right SVC and inferior vena cava cannulation. The connecting vein between right and left SVC was very small in size and it would not have drained LSVC adequately. Hence left SVC was drained by insertion of an 18 Fr left ventricular sump vent catheter (Argyle, Sherwood Medical, USA) via coronary sinus and snugged at an extracardiac site. The tip of the vent catheter was placed just in the extracardiac portion of LSVC. Low suction was applied to the LSVC vent catheter using roller pump revolutions of about 20 -40/min. The LSVC was drained for about 150 min. Intracardiac repair was performed and the patient was weaned off CPB. The duration of CPB was 307 min. Heparin was reversed with protamine after successful weaning from CPB. Postoperatively, the patient maintained stable haemodynamics and was weaned off the ventilator after 18 h of ventilation. The patient did not receive any prophylactic anticoagulation therapy in the immediate postoperative period. Haemoglobin was 12 gm% on the 4th postoperative day. Postoperative echocardiography revealed mild subvalvular pulmonary stenosis. The patient was discharged on the 15th postoperative day. He returned to the hospital 3 days after 1569-9293/$ -see front matter q
postoperative period. Both patients were successfully reoperated. At a mean follow up 36 months, all patients are in NHYA functional Class I and in normal sinus rhythm.
Conclusions:The technical advantages and hemodynamic benefits of this operation are encouraging. A longer follow up in needed to confirm the early results, especially late atrial dysrrhythmias, pulmonary venous destruction, thromboembolic complications and growth.into left atrium. She underwent a total correction where scimitar vein was rerouted to the left atrium through surgically created atrial septal defect under total circulatory arrest. The vertical vein was divided and anastomosed to the left atrial appendage. She made a good recovery and was doing well on followup and echocardiogram showed a normal pulmonary venous drainage.Conclusions: Though rare this combined anomalous pulmonary venous connection can be easily corrected with good results. [-----] bypass -A reality
Bidirectional glenn shunt under veno-venous
Background: Fontan procedure and its modifications are established procedures for the treatment of anatomical defects with a single ventricle physiology.Methods: Thirty-two patients underwent extra-cardiac Fontan procedure between Feb 2004 and Oct 2005. Pre-operative cardiac catheterization was done in all patients. All cases were operated on cardiopulmonary bypass with beating heart. ePTFE conduit (Gore-Tex) was used to create an extra cardiac connection between inferior vena cava and the pulmonary artery. A fenestration was created between the conduit and right atrium in twenty-seven patients (91%) Results: The average age was 8.7 years (range 3-21yrs). Ten females underwent the operation. The pre-operative diagnosis was tricuspid atresia (n=15), DORV (n=8), DILV (n=3) and others (n=6). Three patients had PA banding and eight had a BT shunt prior to the bidirectional Glenn. The average pre-procedure pulmonary artery pressure was 11.9 mm Hg (range 7-16) and LVEDP was 10.6 mm Hg (range 7-18). The average branch PA size was 12.6 mm/m 2 (range 8.9-15). 20mm (n=10) or 22 mm (n=12) PTFE conduits were used. Twenty-nine patients (91%) survived the procedure. Postoperative complications were pleural effusion (n=9), renal failure (n=3) and bleeding (n=1). Technical problems during re-sternotomy (aortic injury in one and coronary artery injury in another) and poor PA anatomy were the causes for mortality. Arterial oxygen saturation increased from an average of 76.33% (pre-operative) to 94.5% (postoperative).Conclusions: Extra cardiac Fontan is a technically simple procedure that avoids an atrial suture line resulting in a theoretical reduction in the risk of atrial arrhythmias. However, careful selection of cases is mandatory to avoid early mortality.
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