Modification of Glenn anastomosis for total cavopulmonary connection conversion after atriopulmonary Fontan
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Modification of Glenn anastomosis for total cavopulmonary connection conversion after atriopulmonary Fontan Hideki Tatewaki1 · Satoshi Fujita1 · Satoshi Kimura1 · Hiromichi Sonoda1 · Akira Shiose1 Received: 17 February 2020 / Accepted: 2 June 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract As several complications can develop after the atriopulmonary Fontan procedure, total cavopulmonary connection conversion is often considered. We report two cases in which total cavopulmonary connection conversion was performed with a modified Glenn procedure. We used an expanded polytetrafluoroethylene graft between the superior vena cava and extracardiac conduit. This procedure ensures that a balanced hepatic blood flow is perfused into both lungs to avoid pulmonary arteriovenous malformations. Keywords Total cavopulmonary connection conversion · Glenn anastomosis · Pulmonary arteriovenous malformations
Introduction Right atrial dilation, arrhythmias, thromboembolism and protein-losing enteropathy have been noted after atriopulmonary anastomosis [1]. Conversion of an atriopulmonary Fontan to an extracardiac Fontan has been attempted to alleviate complications by improving central systemic flow patterns [2]. We report two cases in which Glenn modification was performed for total cavopulmonary connection (TCPC) conversion.
Case 1 The patient was a 32-year-old man with tricuspid atresia and underwent an atriopulmonary Fontan procedure, pulmonary artery (PA) reconstruction at 7 years of age. Exertional dyspnea and arrhythmias were noted 3 years previously. Further examination demonstrated right atrium (RA) dilation, thrombus in the RA and an ascending aorta diameter of Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11748-020-01407-1) contains supplementary material, which is available to authorized users. * Akira Shiose [email protected]‑u.ac.jp 1
Department of Cardiovascular Surgery, Kyushu University Hospital, 3‑1‑1 Maidashi, Higashiku, Fukuoka, Japan
46 mm. Preoperative cardiac catheterization revealed superior vena cava (SVC) and inferior vena cava (IVC) pressure of 14 mmHg. The patient underwent TCPC conversion with a 22-mm extracardiac conduit, PA reconstruction, RA plication, atrial septal defect creation, ascending aorta replacement and epicardial pacemaker implantation. During this surgery, there were severe adhesion around right PA probably due to previous PA reconstruction and the PA wall was very thin like tissue paper. Therefore, we decided to employ this Glenn modification with TCPC conversion. Cardiac catheterization at one year after surgery improved the Fontan circulation, with a mean SVC and extracardiac conduit pressure of 8 and 9 mmHg, respectively (Video). At two years after the surgery, the patient has been doing well in an outpatient clinic.
Case 2 The patient was a 46-year-old man with tricuspid atresia. At 10 years of age, an atriopulmonary Fontan operation was performed. The patient developed exerti
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