Abstract
Objective. To present the variants of surgical tactics in patients with the functionally single ventricle heart and
apicocaval juxtaposition on the basis of the analysis of our own materials and literature data.
Material and methods. 210 Fontan's procedures were performed from 1998 to 2012 in modification of the extracardiac conduit including 23 operations in patients with different complicated congenital heart diseases associated with the apicocaval juxtaposition. The age of patients was from 5 to 26 years old, median 12 years. Oxygenblood saturation was within 60–93 %, median 78 %. As a stage of treatment 20 patients previously underwent thebidirectional cavopulmonary anastomosis operation including two cases in the absence of the hepatic segment ofthe inferior vena cava. The exact localization of the venae cava and anatomy of pulmonary arteries were determined by angiocardiography and computed tomography with contrast agent. The circulation in the conduits inpostoperative period was evaluated by the magnetic resonance tomography.
Results. In 18 patients the extracardiac conduit was implanted in the ipsilateral pulmonary artery and placedunder the apex of the heart. In 5 patients the conduit was implanted in the contralateral pulmonary artery andcrossed the vertebral column. In 2 cases after the Kawashima procedure the collector of hepatic veins was transferred with the help of the extracardiacconduit while in one case of these the conduit was implanted in the ipsilateral pulmonary artery and in the other in the contralateral pulmonary artery. Plastic repair of the insufficiencyof the common atrioventricular valve was performed in 2 patients. In 1 case the two-chamber cardiac pacemakerwas implanted.
11 (48 %) patients had the complicated postoperative period. The complications were represented by the cardiacpulmonary insufficiency (n = 4), hydrothorax (n = 8) associated with the ascites (n = 6). One patient died. Hospitalmortality made up 4.4 %. No trustworthy differences depended on the conduit implantation technique wererevealed in the course of postoperative period. No compression of the conduit depending on its location either bythe vertebral column or heart apex was observed.
Conclusion. Both described techniques for the extracardiac conduit placement have reported good results. It isobvious that the choice of one of them should be determined by the condition of branches of the pulmonary arteryand extent of displacement of the inferior vena cava from the vertebral column.
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