Experience with the Extracardiac Fontan Procedure

Abstract

Introduction: Double patch technique pioneered & published by Novick WM, Sandoval N et. al. for the repair of VSD with severe pulmonary hypertension. (The Annals Of Thoracic Surgery Vo1. 77, No. 1, Jan 2005) indicated good results in the hig risk VSD -closure.Methods: A total of 185 cases of isolated VSD were operated at our hospital since January 1998 -till date. Age ranged between 1 month to 33 years (mean 8.2 years). Sex ratio 1:2 (M:F). Out of 185 cases, 37 cases had normal PA-pressures, 74 had moderate PAH between 40 -60 mmHg and the rest had severe PAH (> 60 mmHg). 5 cases had pulmonary artery pressures (PAP), which were equivalent or little above systemic pressure. In the normal course we would have recommended medical treatment. But we were encouraged to use the double-patch technique, pioneered by Novick WM, Sandoval N et. al. All the 5 cases were females age range between 4 years to 8 years (mean 7 years). VSD was closed on CPB using moderate hypothermia with double patch technique (Sauvage-dacaron patch) through RA. Maneuvers to manipulate the pulmonary artery pressure were undertaken pre-, intra-& post-operatively. Though they had prolonged ventilation and ICU-stay, all of them recovered. PAH continued, though the PAP came down marginally, yet we found that in due course the PAP further fell to mild to moderate level over period of 3 to 4 months.Conclusions: This is a good technique for un-operable VSD with severe pulmonary hypertension and give gratifying results.