title: Percutaneous Transhepatic Fontan-Kreutzer Completion of Hepatic Vein Inclusion.
abstract: We report the case of an 11-year-old girl with heterotaxy syndrome, dextrocardia, and azygos continuation of an interrupted inferior vena cava who had developed pulmonary arteriovenous fistulas after a Kawashima procedure consisting of bilateral superior cavopulmonary anastomoses. She presented with profound cyanosis, fatigue, and failure to thrive. An operative procedure to direct hepatic vein effluent to the pulmonary circulation was performed with placement of an extracardiac conduit between the hepatic veins and the left pulmonary artery. Persistence of cyanosis led to investigation, which led to the discovery of an unintentionally excluded right hepatic vein. A percutaneous transhepatic catheter intervention was performed in which a vascular plug was implanted to occlude the "missed" right hepatic vein, redirecting the flow through intrahepatic venovenous channels to the conduit. Clinical condition and arterial oxygen saturation were substantially improved one year after the two-step hepatic vein inclusion procedure.
authors.affiliation: 1 Division of Congenital Heart Surgery, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Juaneda
authors.affiliation: 2 Division of Pediatric Cardiology, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Peirone
authors.affiliation: 3 Division of Cardiology, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Ferrero Guadagnoli
authors.affiliation: 3 Division of Cardiology, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Contreras
authors.affiliation: 4 Division of Radiology, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
authors.forename: Santiago
authors.initials: S
authors.lastname: Orozco
authors.affiliation: 5 Division of Pediatric Cardiac Intensive Care, Hospital Privado Universitario de Córdoba, Córdoba Argentina.
authors.forename: Juan
authors.initials: J
authors.lastname: Diaz
authors.affiliation: 1 Division of Congenital Heart Surgery, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
authors.forename: Christian
authors.initials: C
authors.lastname: Kreutzer
mesh_terms: D002648:Child; D005260:Female; D018610:Heart Bypass, Right / Q000379:methods*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D011652:Pulmonary Circulation; D014682:Vena Cava, Inferior / Q000601:surgery*
keywords: CHD; Fontan; cardiac catheterization/intervention; cavopulmonary anastomosis; device; fistula; heterotaxy; univentricular heart