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Novel Biventricular Fontan Conversion In Criss-cross And Superior-inferior Ventricles Utilizing Extra-anatomical Left Ventricle Apex To Ascending Aortic Composite Prosthesis.
Hani K. Najm, Brittany Potz, Nicholas Szugye, Munir Ahmad, John P. Costello, Tara Karamlou, Malek El-Yaman, Patcharapong Suntharos.
Cleveland Clinic, Cleveland, OH, USA.
Objectives: We present a novel approach for a biventricular Fontan conversion in a 22 year-old female born with double outlet right ventricle, criss- cross orientation of the atrioventricular valves with superior inferior oriented ventricles, right-handed ventricular topology, large perimembraneous inlet ventricular septal defect with a straddling mitral valve, and bilateral superior vena cavae (thrombosed left SVC) who had prior pulmonary artery banding, atrial septectomy, bidirectional Glenn and lateral tunnel fenestrated Fontan. She developed veno-venous collaterals, subaortic right ventricular outflow obstruction (RVOTO) (peak gradient 90 mmHg) with liver and kidney dysfunction.
Methods: The right ventricle (RV) was moderately hypoplastic with normal function, the left ventricle (LV) was mildly dilated with normal function therefore an LV based biventricular conversion was carried out.
Results: A biventricular conversion was performed including: right ventricular muscle bundle resection, ventricular septal defect patch closure, Fontan takedown, relocation of mitral papillary muscles, LV apex to aortic stented composite graft conduit using a size 28 RelayPro non-bare metal stent graft with a built-in mechanical valve On-X size 23 aortic valve and a size 28 Dacron tube extension. Coronary translocation was performed using Cabroltechnique with an 8 mm Dacron tube. The deficits in the aortic root were patched and the aorta was transected and anastomosed to the left pulmonary artery, making this the neo pulmonary artery.
Conclusions: This novel approach to a biventricular conversion in an adult congenital cardiac patient not only alleviated her subaortic RVOTO, but also reversed the negative side effects of her fontan.
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