No abstract

It is difficult to manage patients with single ventricular physiology and unbalanced pulmonary arteries. Since 1998, we started a novel approach [Intrapulmonary-artery Septation (IPAS)] to improve the result for those with severe unbalanced pulmonary arteries consisting of a well-grown pulmonary artery and an inadequately-grown pulmonary artery. The inadequately-grown pulmonary artery includes severe pulmonary arterial hypoplasia and pulmonary venous obstruction. This approach is based on the following concepts: (1) A reliable blood source should be secured to recover the inadequately-grown pulmonary artery; (2) Wasteful volume-load should be prevented for the heart; (3) Long stenosis or non-confluence of pulmonary artery should be avoided. IPAS primarily consists of (A) a Glenn shunt; (B) a systemic-pulmonary artery shunt; and (C) a septation-patch. Both (A) and (B) are adjoined on a well-grown pulmonary artery, and (C) is placed between (A) and (B). PAS brings two separate blood flows of a Glenn shunt to the well-grown side and SPS on the inadequately-grown side. IPAS was performed in 20 patients. Seventeen reached the Fontan operation. Eleven underwent postoperative catheterization and seven had acceptable-balanced pulmonary blood flow distribution. IPAS can pilot more complicated cases having severe unbalanced pulmonary arteries to the Fontan circulation.

The early outcome of the extracardiac conduit Fontan procedure was satisfactory in patients weighing less than 10 kg. However, the required size of the conduit remains debatable.

Brain MRI is an important tool for the detection of asymptomatic intracranial abnormalities associated with IE and evaluation of the preoperative bleeding risk of patients. Patients with contrast enhancement around black dots are at high risk for bleeding, and performing open heart surgery in such patients whenever possible after the improvement of inflammatory findings reduces the potential risk of cerebral haemorrhage.

The technical feasibility of cardiac bypass in nonhuman primate fetuses weighing less than 1000 g was confirmed. Isoflurane anesthesia appears to be superior to fentanyl and midazolam anesthesia for fetal cardiac surgery because of adequate uterine relaxation.