%0 Journal Article
%T Extracardiac Fontan with T-shape conduit in non-confluent pulmonary arteries
%A Jae Kwak
%A Jeong Lee
%A Woo-Sung Jang
%A Eun Bae
%J Journal of Cardiothoracic Surgery
%D 2008
%I BioMed Central
%R 10.1186/1749-8090-3-7
%X Intrapericardial pulmonary artery creation is inevitable at neonatal period because patient had no confluent pulmonary artery and compliance of pulmonary vascular bed is not ready to accept pulmonary boold flow. Furthermore, adequate inflow pulmonary bed preparation for systemic venous return is crucial for definitive Fontan repair. In this situation, we thought multi-step approach would be helpful for the pulmonary bed growth.A 4 week-old male diagnosed with {S, X, D} type double inlet right ventricle, small left side atrioventricular valve, intact atrial septum, and non-confluent pulmonary arteries with diminutive hilar pulmonary arteries (2.7 and 3 mm diameter) supplied by bilateral patent ductuses was admitted to our unit. Because disconnected pulmonary arterial portion was too long and pulmonary artery hilar portion was too tiny to do unifocalization, we performed central pulmonary artery interposition between both pulmonary arterial hilar portion with 6 mm polytetrafluoroethylene(PTFE) vascular graft and left modified Blalock-Taussig shunt with 4 mm PTFE graft and ductus division under median full sternotomy. Postoperative arterial saturation was 85%.At 9 months, echocardiography and cardiac catheterizing showed that previous left modified BT shunt was stenotic at the anastomosis site with artificial confluent pulmonary artery (PTFE 6 mm vascular graft), and left pulmonary artery orifice was totally occluded, it's distal part was filled by collateral vessels. Both pulmonary arteries were relatively small to his weight and age. We changed 6 mm central pulmonary artery conduit wiht upsized 8 mm PTFE graft and right bidirectional cavopulmonary connection and atrial septectomy was performed concomitantly. During the interstage period after above 2 staged palliative operations, we used coumadin for anticoagulation, tried to maintain INR level between 1.5 and 2.0. At 32 months (14 kg), second cardiac catheterization revealed pressure gradient of 11 mmHg at anastomos
%U http://www.cardiothoracicsurgery.org/content/3/1/7