Advertisement

A successful biventricular repair in an adult case with “common ventricle” and isomeric atrial appendages previously undergoing the conventional Glenn procedure

  • Masahiro Yoshida
  • Toshikatsu Yagihara
  • Hideki Uemura
  • Katsushi Yamashita
  • Yoichi Kawahira
  • Ko Yoshizumi
Case Report

Abstract

We describe herein a successful biventricular repair in a 21-year-old male who had severe hypoplasia of isomeric right appendages. He had previously undergone the conventional Glenn procedure at the age of one and a half years. Although he had grown uneventfully until adolescence, cyanosis as well as fatigue than gradually became worse. When referred to us for further treatment, we deemed a Fontan type procedure to be contraindicated, because of the hypoplastic nature of the right pulmonary artery, and the presence of abundant collateral arteries supplying the right lung. In terms of ventricular morphology, however, because both apical components were present, separated by the hypoplastic septum, biventricular repair seemed feasible. Initially, the Glenn anastomosis was taken down, and systemic-to-pulmonary shunts were constructed via a median sternotomy to both the right and left pulmonary arteries. This was followed by surgical division of the developed collaterals to the right lung via the right thoracotomy. Definitive biventricular repair was then carried out by reconstructing the pulmonary arteries and right ventricular outflow tact, septating and rerouting within the ventricles using a EPTFE patch, and achieving redirection of blood within the atriums using bovine pericardium. Such staged surgical approaches, although extensive, can provide useful options when seeking definitive repair in grown-up patients with complicated malformations.

Keywords

Pulmonary Artery Bovine Pericardium Biventricular Repair Definitive Repair Ventricular Morphology 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1).
    Uemura H, Yagihara T, Kawashima Y, Yamamoto F, Nishigaki K, Matsuki O, Okada K, Kamiya T, Anderson RH: What factors affect ventricular performance after a Fontan-type operation? J Thorac Cardiovasc Surg 110: 405–415, 1995PubMedCrossRefGoogle Scholar
  2. 2).
    Uemura H, Yagihara T, Ishizaka T, Yamashita K: Pulmonary circulation after biventricular repaid in patients with major systemic-to-pulmonary collateral arteries. Eur J Cardiothorac Surg 12: 581–586, 1997PubMedCrossRefGoogle Scholar
  3. 3).
    Triedman JK, Bridges ND, Mayer JE Jr, Lock JE: Prevalence and risk factors for aortopulmonary collateral vessels after Fontan and bidirectional Glenn procedures. J American College of Cardiology 22: 207–215, 1993CrossRefGoogle Scholar
  4. 4).
    Ichikawa H, Yagihara T, Kishimoto H, Isobe F, Yamamoto F, Nishigaki K, Matsuki O, Tsuyoshi F: Extent of aortopulmonary collateral blood flow as a risk factor for Fontan operations. Ann Thoracic Surgery 59: 433–437, 1995CrossRefGoogle Scholar
  5. 5).
    Lamberti JJ, Mainwaring RD, Spicer RL, Uzark KC, Moore JW: Factors influencing perioperative morbidity during palliation of the univentricular heart. Ann Thoracic Surgery 60: S550-S553, 1995CrossRefGoogle Scholar
  6. 6).
    Matsuki O, Yagihara T, Kawashima Y: A new surgical approach for preparation of candidates for the Fontan operation with acquired systemic-pulmonary collateral arteries. Cardiol Young 5: 122–124, 1995Google Scholar

Copyright information

© The Japanese Society of Thoracic and Cadiovascular Surgery 1998

Authors and Affiliations

  • Masahiro Yoshida
    • 1
  • Toshikatsu Yagihara
    • 1
  • Hideki Uemura
    • 1
  • Katsushi Yamashita
    • 1
  • Yoichi Kawahira
    • 1
  • Ko Yoshizumi
    • 1
  1. 1.Departments of Cardiovascular SurgeryNational Cardiovascular CenterOsakaJapan

Personalised recommendations