The fenestrated Kawashima operation for single ventricle with interrupted inferior vena cava

Hannan, Robert L.; Rossi, Anthony F.; Nykanen, David; Lopez, Leo; Alonso, Francisco A.; White, Jeffrey A.; Burke, Redmond P.

doi:10.1016/s0003-4975(02)04281-9

Cited by 12 publications

(10 citation statements)

References 3 publications

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“…In patients with these complex heart malformations the surgical approach can rarely consider the plan toward a bi-ventricular type of repair (1, 2, 32, 34), and therefore complete and precise definition of the morphology of the systemic venous return is necessary for an appropriate planning of the surgical strategy to achieve a uni-ventricular type of repair (1, 2, 7, 9, 29–31, 33–35). …”

Section: Discussionmentioning

confidence: 99%

Systemic venous anomalies in the Middle East

2013

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Introduction: Systemic venous anomalies are quite rare and can be associated with congenital heart disease requiring surgery.Materials and Methods: All consecutive patients (pts) undergoing surgery for congenital heart defects were retrospectively analyzed for presence of systemic venous anomalies: (a) Persistent left superior vena cava (PLSVC)(b) Inferior vena cava (IVC) interruption(c) Retro-aortic innominate veinResults: From 9/2010 to 5/2012 155 pts, median age 7 months, mean age 1.3 years (3 days–50 years), median weight 4 kg, mean weight 7.2 kg (0.6–110 kg) underwent congenital heart surgery. Twenty-nine systemic venous anomalies were identified in 28/155 patients (=18.1%). PLSVC was present in 21 pts (=13.5%), median age 4 months, mean age 2.7 years (3 days–22 years), median weight 6 kg, mean weight 10.1 kg (2.4–43.0 kg). IVC interruption was identified in 5 pts (=3.2%), median age 2 months, mean age 5.4 years (30 days–26 years), median weight 3.7 kg, median weight 17 kg (2.3–68.0 kg). Retro-aortic innominate vein was diagnosed in 3 pts (=1.9%), median age 5 years, mean age 3.7 years (10 months–5 years), median weight 12 kg, mean weight 10.1 kg (4.5–14 kg). Complete pre-operative diagnosis was obtained in 14/28 (=50%) pts with echocardiography and in other 8/28 (=28.6%) only after computed tomography (CT) scan, for a total of 22/28 (=78.6%) correct pre-operative diagnosis. In 6/28 (=21.4%) patients the diagnosis was intra-operative. Total incidence of systemic venous anomalies was 18.1% (vs. 4% in the literature, P = 0.0009), with presence of PLSVC = 13.5% (vs. 0.3–4.0%, respectively P = 0.0004 and P = 0.0012), IVC interruption = 3.2% (vs. 0.1–1.3%, N.S.), and retro-aortic innominate vein = 1.9% (vs. 0.2–1%, N.S.).Conclusions: Our study showed an incidence of systemic venous anomalies in Middle Eastern pts with congenital heart defects higher than previously reported. In 78.6% of pts the diagnosis was correctly made before surgery (echocardiography or CT scan), with 21.4% of complete diagnosis made at surgery. A careful pre-operative screening should be performed in all pts with congenital heart defects from this region to better identify all systemic venous anomalies for a more accurate surgical planning.

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Section: Discussionmentioning

confidence: 99%

Systemic venous anomalies in the Middle East

2013

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“…Little is known about the effects of the Kawashima operation in small young infants. 2 Herein we report a successful result in a 5-month-old patient with progressive cyanosis, in whom an increase of effective pulmonary blood flow was mandatory.…”

Section: Discussionmentioning

confidence: 94%

“…3 However, in this particular circulation, by adding extrapulmonary blood flow to a subtotal Fontan circulation, the concerns of having pulmonary artery and superior vena caval pressures that are too high are very real. 2,3 This is the rationale for decompressing the pulmonary circuit by means of a limited fenestration back into the heart.…”

Section: Discussionmentioning

confidence: 99%

“…ases involving small infants undergoing the Kawashima operation for left atrial isomerism, single ventricle, and azygos continuation of the inferior vena cava are rare and challenging because of the risk associated with this particular circulation, which is similar to a total cavopulmonary shunt, except for the hepatic flow. 1 Taking into account the recent encouraging report from Hannan and associates, 2 we decided to perform a modified fenestrated Kawashima operation, preserving a limited antegrade flow, in a 5 1 ⁄2-month-old infant with severe cyanosis caused by progressive pulmonary stenosis.…”

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Modified fenestration technique for the Kawashima operation in a young infant

Picarelli¹,

Montenegro²,

Antúnez³

et al. 2005

The Journal of Thoracic and Cardiovascular Surgery

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“…In our view, patients with azygos continuation of the IVC to the SVC who have undergone a prior Norwood procedure should be considered for fenestration, particularly if PA development is suboptimal. There are a few case reports of Kawashima procedures 6 –9 with various methods described for creating a fenestration. These cases did not report patients having prior Norwood operations.…”

Section: Discussionmentioning

confidence: 99%

Kawashima by Fenestrated Hemi-Fontan for Palliation Following Prior Stage I Norwood Operation

Zablah

Ross

Wilson

et al. 2018

World J Pediatr Congenit Heart Surg

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Single ventricle patients with interrupted inferior vena cava (IVC) and azygos continuation to the superior vena cava (SVC) are typically palliated with a bidirectional cavopulmonary shunt (BCPS), known as the Kawashima operation in this setting. Because the volume of venous blood directed to the pulmonary arteries is substantially greater in the presence of interrupted IVC, Kawashima procedures are commonly delayed to older age compared to other single ventricle patients undergoing BCPS. We report two young infant single ventricle patients with interrupted IVC and azygos continuation to the SVC who underwent stage I Norwood procedures for initial palliation. In both cases, a fenestrated hemi-Fontan procedure achieved successful Kawashima circulations.

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The fenestrated Kawashima operation for single ventricle with interrupted inferior vena cava

Cited by 12 publications

References 3 publications

Systemic venous anomalies in the Middle East

Systemic venous anomalies in the Middle East

Modified fenestration technique for the Kawashima operation in a young infant

Kawashima by Fenestrated Hemi-Fontan for Palliation Following Prior Stage I Norwood Operation

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