Unusual method of creation of a transcatheter fenestration in an extracardiac conduit fontan circulation

Singhi, Anil Kumar; Sivakumar, Kothandam

doi:10.4103/0974-2069.189112

Cited by 6 publications

(6 citation statements)

References 12 publications

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“…The fenestration and hepatic exclusion both increase cardiac output by allowing deoxygenated blood to flow directly into the heart. In turn, oxygen saturation decreases after these surgical modifications, consistent with clinical data for fenestrated Fontans [9,12]. The fenestration has the largest impact on saturation, with the 8 and 10 mm conduits leading to smaller saturations than seen in the hepatic exclusion.…”

Section: Discussionsupporting

confidence: 76%

“…These changes in pulmonary artery pressure for the fenestration align with results from a surgical report where measurements are taken pre and post operation [9]. Overall, the fenestration seems to relieve pulmonary arterial hypertension while the hepatic exclusion seems to mitigate portal venous hypertension.…”

Section: Discussionsupporting

confidence: 71%

“…14, despite a small increase in the portal venous pressure. In sum, the success of both fenestrations and hepatic exclusions in resolving protein–losing enteropathy may be due to their similar effect on blood flow to the intestines and liver [9,10]. …”

Section: Discussionmentioning

confidence: 99%

“…Different types of fenestrations have been clinically used for the extracardiac Fontan [9,13,52]. We consider a tube fenestration emanating from the extracardiac conduit (the synthetic conduit extending from the inferior vena cava to the pulmonary artery), as described in Ref.…”

Section: Models and Methodsmentioning

confidence: 99%

“…A fenestration is path near the Fontan connection which diverts a small portion of blood directly to the heart [8,9]. In the extracardiac Fontan, a path may be established by creating a small hole in both the continuation of the inferior vena cava and the atrium, and then surgically connecting them together.…”

Section: Introductionmentioning

confidence: 99%

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A computational study of the Fontan circulation with fenestration or hepatic vein exclusion

Puelz

Acosta

Rivière

et al. 2017

Computers in Biology and Medicine

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Fontan patients may undergo additional surgical modifications to mitigate complications like protein–losing enteropathy, liver cirrhosis, and other issues in their splanchnic circulation. Recent case reports show promise for several types of modifications, but the subtle effects of these surgeries on the circulation are not well understood. In this paper, we employ mathematical modeling of blood flow to systematically quantify the impact of these surgical changes on extracardiac Fontan hemodynamics. We investigate two modifications: (1) the fenestrated Fontan and (2) the Fontan with hepatic vein exclusion. Closed–loop hemodynamic models are used, which consist of one–dimensional networks for the major vessels and zero–dimensional models for the heart and organ beds. Numerical results suggest the hepatic vein exclusion has the greatest overall impact on the hemodynamics, followed by the largest sized fenestration. In particular, the hepatic vein exclusion drastically lowers portal venous pressure while the fenestration decreases pulmonary artery pressure. Both modifications increase flow to the intestines, a finding consistent with their utility in clinical practice for combating complications in the splanchnic circulation.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Models and Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A computational study of the Fontan circulation with fenestration or hepatic vein exclusion

Puelz

Acosta

Rivière

et al. 2017

Computers in Biology and Medicine

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Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Zentner

Celermajer

Gentles

et al. 2020

Heart, Lung and Circulation

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The Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a Fontan circulation, and their families to benefit from consensus agreement about management of the person with a Fontan circulation. The document was crafted with input from a multidisciplinary group of health care providers as well as individuals with a Fontan circulation and families. It is hoped that the shared common vision of long-term wellbeing will continue to drive improvements in care and quality of life in this patient population and eventually translate into improved survival.

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Endocardial transvenous pacing in patients with surgically palliated univentricular hearts: A review on different techniques, problems and management

Umamaheshwar

Singh

Sivakumar

2019

Indian Pacing and Electrophysiology Journal

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Fontan surgery and its modifications have improved survival in various forms of univentricular hearts. A regular atrial rhythm with atrioventricular synchrony is one of the most important prerequisite for the long-term effective functioning of this preload dependent circulation. A significant proportion of these survivors need various forms of pacing for bradyarrhythmias, often due to sinus nodal dysfunction and sometimes due to atrioventricular nodal block. The diversion of the venous flows away from the cardiac chambers following this surgery takes away the simpler endocardial pacing options through the superior vena cava. The added risks of thromboembolism associated with endocardial leads in systemic ventricles have made epicardial pacing as the procedure of choice. However challenges in epicardial pacing include surgical adhesions, increased pacing thresholds leading to early battery depletion and frequent lead fractures. When epicardial pacing fails, endocardial lead placement is equally challenging due to lack of access to the cardiac chambers in Fontan circulation. This review discusses the univentricular heart morphologies that may warrant pacing, issues about epicardial pacing, different techniques for endocardial pacing in patients with disconnected superior vena cava, pacing in different modifications of Fontan surgeries, issues of systemic thromboembolism with endocardial leads, atrioventricular valve regurgitation attributed to pacing leads and device infections. In a vast majority of patients following Glenn shunt and Senning surgery, an epicardial pacing and lead replacement is always feasible though technically very difficult. This article highlights the different options of transatrial and transventricular endocardial pacing.

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Unusual method of creation of a transcatheter fenestration in an extracardiac conduit fontan circulation

Cited by 6 publications

References 12 publications

A computational study of the Fontan circulation with fenestration or hepatic vein exclusion

A computational study of the Fontan circulation with fenestration or hepatic vein exclusion

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Endocardial transvenous pacing in patients with surgically palliated univentricular hearts: A review on different techniques, problems and management

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