Innominate vein turn-down procedure: Killing two birds with one stone

Abstract

Innominate vein turn-down procedure improves lymphatic drainage by decompressing the thoracic duct to the lowerpressure system, with concomitant increase of systemic preload in Fontan circulation.See Commentaries on pages 261 and 263.

At the forefront of congenital cardiothoracic surgery: 2020-2021

“…19 Failing Fontan circulation presents an everincreasing challenge to our surgical community. A group of experts lead by Hraska 20 reviewed the recent experience of interventional and surgical management of complications of impeded lymphatic drainage in Fontan circulation and discussed the rationale for and the outcomes of the innovative innominate vein turn-down procedure. While the indications for durable ventricular assist devices appear to evolve, it is clear that an early listing for heart transplantation before end-organ injury occurs is warranted.…”

Plastic Bronchitis—A Serious Rare Complication Affecting Children Only after Fontan Procedure?

“…The condition has been reported at every age; however, it has been predominantly seen in children who have undergone Fontan palliative surgical procedure for congenital heart disease (CHD) [ 1 ]. PB is a serious and life-threatening complication, as is a protein losing enteropathy (PLE) [ 2 ], since both conditions are associated with a lymphatic system dysfunction [ 3 ]. Rarely has PB occurred in patients with a chronic pulmonary disease such as asthma, cystic fibrosis, lymphangiomatosis, acute chest syndrome associated with sickle cell disease, and after heart transplantation [ 1 , 4 , 5 , 6 ].…”

Commentary: Fontan circulation with lymphatic failure: Was the Holy Grail finally found?

“…The innominate vein turndown procedure was introduced to manage the lymphatic failure by decompressing the thoracic duct with concomitant increase of preload. 6 In their article in this issue of the Journal , Hraška and colleagues 7 describe the progress that has been made in the diagnosis of lymphatic failure using magnetic resonance imaging, the selective lymphatic embolization that has been successfully used to treat plastic bronchitis, and the refined modifications of the original surgical procedure (interposition of a ring-reinforced polytetrafluoroethylene graft to connect the innominate vein to the atrium using a dunk technique in case of a short innominate vein and banding of the jugular vein in case of desaturation below 80% after the procedure). The authors report 1 early death and 3 late deaths in 14 patients.…”

“…This is indeed remarkable, considering that this procedure was performed as “last resort” therapy. 7 …”