Fontan type procedure in patient with borderline hemodynamics: using a temporary R-L shunt in early postoperative period
Yamazaki, K.; Imai, Y.; Kurosawa, H.; Sawatari, K.; Higashidate, M.; Kawada, M.; Koh, H.; Terada, M.; Yamagishi, M.; Hiramatsu, K.
Kyobu Geka. Japanese Journal of Thoracic Surgery 44(12): 984-989
1991
ISSN/ISBN: 0021-5252 PMID: 1758115 Document Number: 384597
Fontan type procedure was successfully performed to a 14-year-old patient with borderline hemodynamics using a temporary R-L shunt in early post operative period. Preoperative diagnosis was DORV (ILD), small RV, PS, ASD, juxtaposition of atrial appendages and post bilateral B-T shunts. Preoperative catheterization studies showed low PARI but insufficient pulmonary arterial size (PA-index 220). In the Fontan procedure, RA was partitioned obliquely with a composite patch of xenograft and Dacron velour. A 5.5 mm hole was created only in xenograft to allow a temporary R-L shunt. During rewarming period, systemic pressure hovering around 60 mmHg with 10 micrograms/kg/min of dopamine and dobutamine. Then a R-L shunt was created by a side to side anastomosis between the appendages with the orifice diameter of 10 mm, followed by a rise in the systemic pressure up to about 80 mmHg. One post operative day, a readjustable occluder was applied at the site of appendage anastomosis to control R-L shunt flow. According as CVP decreased, the occluder was tightened up step by step. Finally, the occluder was fully tightened up in 10 post operative days. This experience suggests that a temporary R-L shunt in early post operative period may be applicable in patient with borderline hemodynamics for Fontan type procedure.