Fontan Revision with Y-Graft in a Patient with Unilateral Pulmonary Arteriovenous Malformation

Lee, Jeong-Woo; Park, Jeong-Jun; Goo, Hyun Woo; Ko, Jesang

doi:10.5090/kjtcs.2017.50.3.207

Cited by 2 publications

(3 citation statements)

References 8 publications

(9 reference statements)

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“…[7][8][9][10] Asymmetric delivery of hepatic venous effluent has been associated with development of unilateral PAVMs and cyanosis, and PAVMs have regressed with more equitable distribution. [11][12][13][14][15] There are several described methods of hepatic vein incorporation (HVI). Historical techniques include the intracardiac and extracardiac Fontan configurations: lateral tunnel or extracardiac conduit to the undersurface of the pulmonary artery (PA), either directly opposite or with contralateral offset to the (dominant if bilateral) superior vena cava (SVC).…”

Section: Introductionmentioning

confidence: 99%

“…[16][17] More recently described are T-grafts, Y-grafts, and direct connection of the HVs into the azygos system. 11,[13][14][18][19][20] These techniques can be technically challenging, however, requiring dissection of fragile PAs in a reoperative situation or necessitating an operative field in the thoracic and potentially abdominal cavities.…”

Section: Introductionmentioning

confidence: 99%

“…7 –10 Asymmetric delivery of hepatic venous effluent has been associated with development of unilateral PAVMs and cyanosis, and PAVMs have regressed with more equitable distribution. 11 –15…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hepatic Vein Incorporation Into the Azygos System in Heterotaxy and Interrupted Inferior Vena Cava

Montesa

Karamlou

Ratnayaka

et al. 2019

World J Pediatr Congenit Heart Surg

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Background: Patients with heterotaxy, single ventricle and interrupted inferior vena cava are at risk of developing significant pulmonary arteriovenous malformations and cyanosis, and inequitable distribution of hepatic factor has been implicated in their development. We describe our experience with a technique for hepatic vein incorporation that reliably provides resolution of cyanosis and presumably equitable hepatic factor distribution. Methods: A retrospective review of a single-surgeon experience was conducted for patients who underwent this modified Fontan operation utilizing an extracardiac conduit from the hepatic veins to the dominant superior cavopulmonary connection. Preoperative characteristics and imaging, operative details, and postoperative course and imaging were abstracted. Results: Median age at operation was 5 years (2-10 years) and median weight was 19.6 kg (11.8-23 kg). Sixty percent (3/5) of patients had Fontan completion without cardiopulmonary bypass, and follow-up was complete at a median of 14 months (range 1-20 months). Systemic saturations increased significantly from 81% + 1.9% preoperatively to 95% + 3.5% postoperatively, P ¼ .0008. Median length of stay was 10 days (range: 7-14 days). No deaths occurred. One patient required reoperation for bleeding and one was readmitted for pleural effusion. Postoperative imaging suggested distribution of hepatic factor to all lung segments with improved pulmonary arteriovenous malformation burden. Conclusions: Hepatic vein incorporation for patients with heterotaxy and interrupted inferior vena cava should optimally provide equitable pulmonary distribution of hepatic factor with resolution of cyanosis. The described technique is performed through a conventional approach, is facile, and improves cyanosis in these complex patients.

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