title: [Fontan type procedure in patient with borderline hemodynamics: using a temporary R-L shunt in early postoperative period].
abstract: 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.
authors.affiliation: Department of Pediatric Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
authors.forename: K
authors.initials: K
authors.lastname: Yamazaki
authors.forename: Y
authors.initials: Y
authors.lastname: Imai
authors.forename: H
authors.initials: H
authors.lastname: Kurosawa
authors.forename: K
authors.initials: K
authors.lastname: Sawatari
authors.forename: M
authors.initials: M
authors.lastname: Higashidate
authors.forename: M
authors.initials: M
authors.lastname: Kawada
authors.forename: H
authors.initials: H
authors.lastname: Koh
authors.forename: M
authors.initials: M
authors.lastname: Terada
authors.forename: M
authors.initials: M
authors.lastname: Yamagishi
authors.forename: K
authors.initials: K
authors.lastname: Hiramatsu
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D006325:Heart Atria / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011651:Pulmonary Artery / Q000601:surgery*