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Novel Surgical Technique for the Prevention of Pulmonary Arteriovenous Malformations in Left Isomerism
Won Young Lee, Eun Seok Choi, Chun Soo Park, Tae-Jin Yun
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
Purpose : In patients with left atrial isomerism (LAI), poor mixing of the hepatic venous flow to the pulmonary artery ipsilateral to the azygos (or hemiazygos) vein after the Kawashima operation (KO) or the completion Fontan operation (FO) may lead to the development of pulmonary arteriovenous malformation (PAM) in the corresponding lung. To address this issue, we developed technical modifications for KO and the completion FO.
Methods : Four patients with LAI underwent modified KO and, among them, three proceeded to the completion FO. Their age at KO and completion FO were 17-19 months and 38-50 months, respectively. Technical modification for KO was the anastomosis of the dominant superior vena cava (SVC) or the innominate vein to the geometric center of the pulmonary artery to allow even distribution of the pulsatile forward flow from the heart to the both lungs. Technical modification of Fontan completion was the anastomosis of the extracardiac conduit to the dominant SVC or geometic center of the pulmonary artery to guarantee the even distribution of the hepatic venous return to the both lungs.
Results : There was no postoperative mortality or morbidity. In three patients with completion FO, post-Fontan magnetic resonance image or computed tomography showed no pulmonary arteriovenous malformations and even distribution of the hepatic venous flow to the right and left lungs.
Conclusion : This novel surgical approach may provide a reliable mixing and bilateral distribution of hepatic venous blood in this subset.
Methods : Four patients with LAI underwent modified KO and, among them, three proceeded to the completion FO. Their age at KO and completion FO were 17-19 months and 38-50 months, respectively. Technical modification for KO was the anastomosis of the dominant superior vena cava (SVC) or the innominate vein to the geometric center of the pulmonary artery to allow even distribution of the pulsatile forward flow from the heart to the both lungs. Technical modification of Fontan completion was the anastomosis of the extracardiac conduit to the dominant SVC or geometic center of the pulmonary artery to guarantee the even distribution of the hepatic venous return to the both lungs.
Results : There was no postoperative mortality or morbidity. In three patients with completion FO, post-Fontan magnetic resonance image or computed tomography showed no pulmonary arteriovenous malformations and even distribution of the hepatic venous flow to the right and left lungs.
Conclusion : This novel surgical approach may provide a reliable mixing and bilateral distribution of hepatic venous blood in this subset.
첨부파일 : 소아분야초록kawa.template.pptx
책임저자: Tae-Jin Yun
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
발표자: Won Young Lee, E-mail : william330@naver.com