Constantine Mavroudis, MD, Carl L. Backer, MD, Barbara J

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Presentation transcript:

Fontan Conversion To Cavopulmonary Connection And Arrhythmia Circuit Cryoablation Constantine Mavroudis, MD, Carl L. Backer, MD, Barbara J. Deal, MD, Christopher L. Johnsrude, MD The Journal of Thoracic and Cardiovascular Surgery Volume 115, Issue 3, Pages 547-556 (March 1998) DOI: 10.1016/S0022-5223(98)70316-2 Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1 Diagrammatic representation of an open right atrial view in an atriopulmonary Fontan patient, without residual atrial shunts, who has been placed on normothermic aortobicaval cardiopulmonary bypass en route to EP mapping and arrhythmia circuit cryoablation, cavopulmonary artery conversion, and atrial antitachycardia pacemaker placement. A right atrial bipolar wire served as the reference electrode and electrical pathway for arrhythmia stimulation. A hand-held electrode is used to perform the EP mapping.16 The Journal of Thoracic and Cardiovascular Surgery 1998 115, 547-556DOI: (10.1016/S0022-5223(98)70316-2) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 2 Diagrammatic representation of an open right atrial view (see Fig. 1). Tachycardia was localized in three major areas: Area 1, the area between the coronary sinus os and the inferior vena cava os, as well as the area between the atrioventricular valve anulus and the inferior vena cava os; Area 2, the lateral atriotomy, which corresponded to the length of the crista terminalis; and Area 3, the region at the superior limbus corresponding to the prior atrial septal defect patch. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 547-556DOI: (10.1016/S0022-5223(98)70316-2) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 3 Diagrammatic representation of a total cavopulmonary artery extracardiac conversion in a patient with an established classic right Glenn/right atrium–to–left pulmonary artery Fontan connection. An aortic homograft was used to connect the left pulmonary artery with the inferior vena cava using the favorable curve of the ascending and transverse arch of the homograft. The Glenn anastomosis was connected side-to-side to the homograft to complete the reconstruction. A transmural bipolar steroid-eluting atrial lead (Medtronic, Inc., Minneapolis, Minn.) is placed in the left atrial appendage for antitachycardia pacemaker placement. Ao, Aorta; APL, antitachycardia pacemaker lead; IVC, inferior vena cava; SVC, superior vena cava; LPA, left pulmonary artery; RPA, right pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 547-556DOI: (10.1016/S0022-5223(98)70316-2) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 4 Total cavopulmonary artery extracardiac Fontan conversion (see Fig. 3). Occasionally, the aortic homograft may require a PTFE graft extension (composite graft) to connect the left pulmonary artery with the inferior vena cava. The Glenn anastomosis can be connected to the homograft as appropriate. Abbreviations as in Fig. 3. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 547-556DOI: (10.1016/S0022-5223(98)70316-2) Copyright © 1998 Mosby, Inc. Terms and Conditions