Alternativa para operação tipo Fontan extracardíaco: anastomose direta entre o tronco pulmonar e a veia cava inferior

Abstract

CLINICAL DATA We report a case of a 9-year-old boy, weighing 20.8 kg, born in Salvador, BA. Cyanosis had been reported since birth by his mother, and two years ago she noticed a worsening in his physical condition when he started presenting episodes of dyspnea and fatigue with mild exertion. He was not taking any medication and had no previous surgical interventions.On physical examination, he was in a good health condition, red-faced, hydrated, cyanosis ++++/4+, and digital hipocratism. Systolic fremitus ++/4+ on the left upper sternal border was perceptible on the precordial region, cardiac auscultation with two clicks with a hyperphonetic second heart sound (S 2 ), and systolic murmur ++++/6+ on upper sternal border irradiating to the right. Abdomen was normal. Peripheral pulses were present and symmetrical, and peripheral saturation was 73% on ambient air. ELECTROCARDIOGRAM Electrocardiogram showed sinusal rhythm and a heartbeat of 100 bpm; SÂP +30º, SÂQRS +240º, PR interval of 0.12 seconds, and QTC of 0.43 seconds. Right ventricular overload evidenced by Rs complex in Vs and rS complex in lead V6. RADIOGRAMOn radiogram visceral situs solitus was present at levocardia. The cardiac area was within normal limits presenting a cardiothoracic index of 0.41. We could not see atrium image on the right, which attracted our attention in addition to the lobulation of the medial portion of right hemidiaphragm suggesting Morgagni hernia or fat tissue hernia. The transparence of the pleuropulmonary fields was normal (Figure 1). ECHOCARDIOGRAMSitus solitus was present at levocardia. Venoatrial and

Operação de Fontan: uma técnica em evolução

“…Computer modeling of fluid dynamics of the effects of exercise on hemodynamics of two techniques recently developed have demonstrated the superiority of the external conduit when compared to the lateral tunnel [23]. For this reason, the vast majority of the techniques presented recently in the literature is based on the concept of external conduit [24][25][26][27][28].…”