The Benefits of an Intracardiac Conduit in the Fontan Operation for Complex Systemic Venous Anomalies in Patients with Single Ventricle Physiology.
Teerapong Tocharonechok, Chodchanok Vijarnsorn, Prakul Chanthong et al.
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Case in brief
The report describes four patients with single-ventricle physiology and complex systemic venous anatomy who underwent Fontan-related surgery using an intracardiac conduit (ICC). The cases included levocardia, apicocaval juxtaposition, interrupted inferior vena cava, bilateral superior vena cava, and anomalous hepatic venous drainage. Conduit connections were tailored to the anatomy, including hepatic-vein-to-pulmonary-artery connections and, in one patient, a staged approach with two fenestrations before later physiologic Fontan completion. All four recovered with unobstructed conduits and had no reported thromboembolic or bleeding events while anticoagulated.
What made this case unusual
The ICC approach was used to address the routing and potential compression problems of an extracardiac conduit in patients with apicocaval juxtaposition and other complex venous anomalies. One patient’s two-fenestration conduit allowed gradual change in ventricular preload before later closure of the larger fenestration.
Diagnostic / clinical pearl
In selected patients with single-ventricle physiology and complex systemic venous anatomy, an intracardiac conduit can be configured to connect venous return to the pulmonary arteries while accommodating unusual caval or hepatic venous drainage.