Heart transplantation after Fontan procedure in adults.
Complex congenital heart disease is the cause for 1.5%-2.4% of heart transplantations in adults. Indications for heart transplantation are ventricular dysfunction, failed Fontan physiology, and cyanosis. We present a 43-year-old man, 20 years after a Fontan operation by an univentricular heart, with a tricuspid atresia, L-Transposition of the Great Arteries, and high-grade subpulmonary stenosis. Persistent bleeding after successful transplantation necessitated major blood transfusions and reoperation. We reconstructed superior vena cava and vena brachiocephalica using a pericardial patch, and because of postoperative low output syndrome, he was connected to extracorporeal circulation through cannulation of femoral artery and explanted after hemodynamic stability. Heart transplantation can be successful in patients with end-stage congenital heart diseases after Fontan procedure, because of improved surgical and medical management. Challenges include limited ability to assess hemodynamics, complex anatomy, increased risk of bleeding caused by multiple prior procedures, and unique underlying pathologic states. Careful patient selection and surgical timing are essential to increase long-term survival.
Department of Cardiac Surgery, Heart and Diabetes Center, North-Rhine Westphalia, Bad Oeynhausen, Germany.
Tolga S
TS
Coskun
Oguz K
OK
Coskun
Mahmut
M
El Arousy
Ute
U
Blanz
Kerstin
K
Bockhorst
Gero
G
Tenderich
Andreas
A
Bairaktaris
Deniz
D
Kececioglu
Reiner
R
Körfer
D000328:Adult; D001803:Blood Transfusion; D001807:Blood Vessel Prosthesis; D002404:Catheterization; D005112:Extracorporeal Circulation; D005263:Femoral Artery / Q000601:surgery; D018729:Fontan Procedure; D016027:Heart Transplantation; D006439:Hemodynamics; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D007902:Length of Stay; D008297:Male; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000601:surgery; D012086:Reoperation; D014188:Transposition of Great Vessels / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome; D018785:Tricuspid Atresia / Q000150:complications / Q000601:surgery; D014683:Vena Cava, Superior / Q000601:surgery