Prabhu Sudesh, Anderson Ben, Ward Cameron, Karl Tom, Alphonso Nelson
1 Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital, Brisbane, Australia.
2 UQ School of Medicine, University of Queensland, Brisbane, Australia.
World J Pediatr Congenit Heart Surg. 2017 Jan;8(1):92-98. doi: 10.1177/2150135116663697.
We report a simple technique for an interventional extracardiac Fontan (ECF) procedure.
At the preparatory stage along with a bidirectional cavopulmonary connection (BCPC; cardiopulmonary bypass), a short piece of polytetrafluoroethylene (PTFE) tube graft is anastomosed to the inferior surface of the right pulmonary artery. Another longer PTFE graft is anastomosed to the transected inferior vena cava (IVC). A large medial opening in the lower PTFE graft is anastomosed to an atriotomy. These two PTFE tubes are anastomosed with a pericardial patch interposed between them. During the later interventional Fontan procedure, this pericardial patch is perforated using radiofrequency, and a covered stent is positioned entirely within the PTFE tubes, eliminating the window into the common atrium and leaving no intrapulmonary prosthetic material.
The hemodynamics after the preparatory stage is similar to those following a BCPC, with uninterrupted flow from the IVC to the right atrium. On completion, there is a nonfenestrated Fontan circuit.
Our technique of interventional Fontan, anatomically and hemodynamically, mimics a standard ECF procedure.
我们报告一种用于介入性心外膜Fontan（ECF）手术的简单技术。
在准备阶段，连同双向腔肺连接（BCPC；体外循环）一起，将一小段聚四氟乙烯（PTFE）人工血管吻合到右肺动脉的下表面。另一段更长的PTFE人工血管吻合到横断的下腔静脉（IVC）。下部PTFE人工血管上的一个大的内侧开口吻合到心房切开处。这两根PTFE管之间夹着心包补片进行吻合。在随后的介入性Fontan手术中，使用射频在心包补片上打孔，并将一个覆膜支架完全放置在PTFE管内，消除通向共同心房的窗口，且不残留肺内假体材料。
准备阶段后的血流动力学与BCPC后的相似，下腔静脉到右心房的血流不间断。完成后，形成一个无窗的Fontan循环。
我们的介入性Fontan技术在解剖学和血流动力学上模拟了标准的ECF手术。
