Innominate Vein Turn-down Procedure for Failing Fontan Circulation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2020;23:34-40
Date
05/02/2020Pubmed ID
32354545DOI
10.1053/j.pcsu.2020.01.002Scopus ID
2-s2.0-85080101619 (requires institutional sign-in at Scopus site) 15 CitationsAbstract
After the Fontan, systemic venous hypertension induces pathophysiologic changes in the lymphatic system that can result in complications of pleural effusion, ascites, plastic bronchitis, and protein losing enteropathy. Advances in medical therapy and novel interventional approaches have not substantially improved the poor prognosis of these complications. A more physiological approach has been developed by decompression of the thoracic duct to the lower pressure common atrium with a concomitant increase of preload. Diverting the innominate vein to the common atrium increases the transport capacity of the thoracic duct, which in most patients enters the circulation at the left subclavian-jugular vein junction. Contrary to the fenestrated Fontan circulation, in which the thoracic duct is drained into the high pressure Fontan circulation, turn down of the innominate vein to the common atrium effectively decompresses the thoracic duct to the lower pressure system with "diastolic suctioning" of lymph. Innominate vein turn-down may be considered for medical-refractory post-Fontan lymphatic complications of persistent chylothorax, plastic bronchitis, and protein losing enteropathy. Prophylactic innominate vein turn-down may also be considered at time of the Fontan operation for patients that are higher risk for lymphatic complications.
Author List
Hraska V, Mitchell ME, Woods RK, Hoffman GM, Kindel SJ, Ginde SAuthors
Salil Ginde MD, MPH Associate Professor in the Pediatrics department at Medical College of WisconsinGeorge M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Viktor Hraska MD Professor in the Surgery department at Medical College of Wisconsin
Steven J. Kindel MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Brachiocephalic VeinsChild
Child, Preschool
Decompression, Surgical
Female
Fontan Procedure
Heart Atria
Humans
Infant
Lymphatic System
Male
Postoperative Complications
Thoracic Duct
