Background: Since its introduction in 1970s, Fontan operation underwent several modifications, including the most commonly used extracardiac technique. Extracardiac extracardiac Fontan may not be suited for some cases such as
1. Abnormal pulmonary venous drainage to lower SVC
2. Hepatic veins draining to a left sided IVC, controlateral to the side of previous Kawashiama shunt
3. Abnormal separate drainage of hepatic veins.
We present an early experience of novel Fontan modification in seven such cases. Video recording of the surgical technique will also be presented.
Methods and Results:
Between January 2000 and August 2007, 181 Cases underwent Fontan operation at the PSCC, Riyadh. Seven of them underwent fenestrated Intra-to-extracardiac Fontan.Three patients had an abnormal pulmonary venous drainage to lower SVC. Two pateints previously underwent Kawashima shunt for interrupted IVC with azygous continuation, they were found to have hepatic veins draining to a left sided IVC, controlateral to the side of Kawashiama shunt. Two patients with abnormal separate drainage of hepatic veins. Short term clinical outcome of these cases was compared to other cases who underwent the usual extracardiac Fontan.
No deaths in the intra to extra cardiac group. No significant difference was found between Intra-to-extracardiac and extracardiac groups in terms of post operative saturation(85-92%), duration of chest drainage (10.14 vs 8.6 days), and hospital stay (15.4 vs 13.3 days).
Conclusions:
Intra-to-extracardiac Fontan is a useful technique in cases with difficult anatomy. Due to the small number of patients in the Intra-to-extracardiac Fontan, comparison with other Fontan modification may be difficult.