Sidra Heart Center, Sidra Medicine, Doha, Qatar.
Department of Pediatrics, Weill Cornell Medicine, Doha, Qatar.
Catheter Cardiovasc Interv. 2024 Aug;104(2):264-271. doi: 10.1002/ccd.31131. Epub 2024 Jul 8.
Patients with functionally univentricular hearts are usually palliated surgically. There have been several reports of successful attempts to complete the Fontan procedure without surgery. The pathways created at the time of the preconditioning were largely reminiscent of the lateral tunnel Fontan. However, this approach is still confidentially limited to a small number of centers. In 2013, we designed a circuit that mimics the actual surgical technique of extracardiac total cavopulmonary connection to allow for transcatheter completion in an animal study. A polytetrafluoroethylene conduit was connected between the pulmonary artery and the inferior vena cava (IVC). The superior anastomosis was occluded to avoid flow between IVC and superior vena cava (SVC). The conduit was connected to the right atrium (RA) and a large fenestration was created to allow free flow from the IVC to the RA. Extrapolating our approach, a center reported the successful transcatheter completion of an extracardiac Fontan in a 6-year-old child. However, this technique is not directly transposable to our population of patients who require preconditioning in infancy. We report here an innovative extension of this technique that may allow preparing patients in infancy, ideally at the time of the Glenn in the future, to receive an extracardiac Fontan at 2 years/11 kg without additional surgery.
患有功能性单心室的患者通常需要接受手术姑息治疗。已经有几例成功尝试在不进行手术的情况下完成 Fontan 手术的报道。在预处理时创建的途径在很大程度上类似于外侧隧道 Fontan。然而，这种方法仍然仅限于少数中心。2013 年，我们设计了一种回路，模拟了体外全腔肺动脉连接的实际手术技术，以便在动物研究中通过经导管完成。聚四氟乙烯导管连接在肺动脉和下腔静脉（IVC）之间。上吻合口被阻塞，以避免 IVC 和上腔静脉（SVC）之间的血流。导管连接到右心房（RA），并创建了一个大的窗孔，以允许 IVC 自由流入 RA。根据我们的方法推断，有一个中心报告了在一名 6 岁儿童中成功经导管完成了体外 Fontan。然而，这种技术不能直接应用于我们需要在婴儿期进行预处理的患者群体。我们在此报告该技术的创新延伸，这可能允许在婴儿期（理想情况下是在未来 Glenn 手术时）为患者做好准备，以便在 2 岁/11 公斤时无需额外手术即可接受体外 Fontan。
