Eight years after an early primary Kawashima operation

Picarelli, Dante; Kreutzer, Christián; Antúnez, Serrana

doi:10.1016/j.jtcvs.2011.01.004

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…Previous studies have shown that being able to control antegrade pulmonary flow in the Kawashima procedure can prevent or delay the development of pulmonary arteriovenous fistulas by exposure of the pulmonary bed to hepatic flow [ 22 ]. However, this also leads to the development of large veno-venous collaterals that redirect the pulmonary flow to the heart and high blood pressure in the PA.…”

Section: Discussionmentioning

confidence: 99%

A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation

Lashkarinia

Çiçek

Kose

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES To evaluate the hemodynamicdynamic advantage of a new Fontan surgical template that is intended for complex single-ventricle patients with interrupted inferior vena cava-azygos and hemi-azygos continuation. The new technique has emerged from a comprehensive pre-surgical simulation campaign conducted to facilitate a balanced hepatic flow and somatic Fontan pathway growth after Kawashima procedure. METHODS For 9 patients, aged 2 to18 years, majority having poor preoperative oxygen saturation, a pre-surgical computational fluid dynamics customization is conducted. Both the traditional Fontan pathways and the proposed novel Y-graft templates are considered. Numerical model was validated against in vivo phase-contrast magnetic resonance imaging data and in vitro experiments. RESULTS The proposed template is selected and executed for 6 out of the 9 patients based on its predicted superior hemodynamic performance. Pre-surgical simulations performed for this cohort indicated that flow from the hepatic veins (HEP) do not reach to the desired lung. The novel Y-graft template, customized via a right- or left-sided displacement of the total cavopulmonary connection anastomosis location resulted a drastic increase in HEP flow to the desired lung. Orientation of HEP to azygos direct shunt is found to be important as it can alter the flow pattern from 38% in the caudally located direct shunt to 3% in the cranial configuration with significantly reversed flow. The postoperative measurements prove that oxygen saturation increased significantly (P-value = 0.00009) to normal levels in 1 year follow-up. CONCLUSIONS The new Y-graft template, if customized for the individual patient, is a viable alternative to the traditional surgical pathways. This template addresses the competing hemodynamic design factors of low physiological venous pressure, high postoperative oxygen saturation, low energy loss and balanced hepatic growth factor distribution possibly assuring adequate lung development. Date and number of IRB approval 25 October 2019, 280011928-604.01.01.

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Section: Discussionmentioning

confidence: 99%

A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation

Lashkarinia

Çiçek

Kose

et al. 2022

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…There was no evidence of pulmonary arteriovenous fistulas. Negative results of bubble contrast echocardiography 6 were ac-companied by a pulmonary venous saturation of 98%, a normal pulmonary arterial-venous transit time, and absence of reticular spongy pattern on pulmonary angiography. A significant right to left shunt through the modified fenestration, however, was revealed.…”

mentioning

confidence: 99%