Complicação pós-operatória de Fontan: fluxo pulmonar anterógrado

Abstract

operations of total cavopulmonary connections were performed in our department, 106 (71.2%) with extracorporeal circulation and 46 (28.8%) without this procedure. The ligation of the pulmonary trunk was performed with the use of cardiac tape attached to the pulmonary trunk wall with three separate polypropylene sutures 5-0 in 131 cases (86.1%). The transthoracic echocardiography with color-flow mapping performed before hospital discharge showed no residual antegrade flow.The suspected diagnosis of pulmonary residual flow was performed by auscultation of systolic murmur over the pulmonary area, and confirmed by echocardiogram. Case 1An 11-year-old female, 24.9 kg, with a diagnosis of transposition of great arteries with hypoplastic left ventricle and pulmonary stenosis, who underwent atrial septostomy on her third day of life, a right modified Blalock when she was 1 year and 2 months, and bidirectional Glenn + Fontan operation with an extracardiac conduit and pulmonary artery ligation without extracorporeal circulation at 8 years old. In the late postoperative period, 2 years after surgery, the mother reported fatigue and eyelid edema in the morning.During diagnostic investigation, doppler echocardiography showed antegrade pulmonary flow (gradient of 81 mmHg) and origin of the pulmonary arteries stenosis, especially on the left. The magnetic angioresonance showed critical stenosis of the left pulmonary artery and aneurysm of the proximal stump of the pulmonary trunk (Figure 1). Fig. 1 -Aneurysms of the pulmonary trunk and branch pulmonary stenosis caused by banding SVC -superior vena cava, RPA -right pulmonary arteryStudy conducted the Heart