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Igor E. Konstantinov
Francisco J. Puga
Vladimir V. Alexi-Meskishvili
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Right arrow Congenital - cyanotic

Ann Thorac Surg 2001;72:1641-1644
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Thrombosis of intracardiac or extracardiac conduits after modified Fontan operation in patients with azygous continuation of the inferior vena cava

Igor E. Konstantinov, MDa, Francisco J. Puga, MD*a, Vladimir V. Alexi-Meskishvili, MD, PhDb

a Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
b German Heart Institute, Berlin, Germany

Accepted for publication July 20, 2001.

* Address reprint requests to Dr Puga, Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55902, USA
e-mail: fpuga{at}mayo.edu

Background. The Fontan procedure in patients with azygous continuation of the inferior vena cava, requires a cavo-pulmonary anastomosis, and deviation of the hepatic venous drainage to the pulmonary arteries using an intra- or extracardiac conduit.

Methods. We report thrombosis of two pericardial conduits and one Gore-Tex (W. L. Gore & Assoc, Flagstaff, AZ) graft used for deviation of hepatic venous blood to the pulmonary arterial tree in 3 patients aged 11, 24, and 28 years. Two of the conduits (pericardial) were intraatrial. The Gore-Tex graft was placed in an extracardiac position. The two pericardial conduits obstructed completely.

Results. One patient died at reoperation. In the 2nd patient, the conduit was excised and the hepatic veins were allowed to drain into the atrium. In the 3rd patient, partial thrombosis of the Gore-Tex conduit was noted 30 months after operation. The thrombus resolved with oral anticoagulation.

Conclusions. Conduits carrying only hepatic venous blood flow may have a higher risk of thrombosis. Anticoagulation or alternative methods of directing hepatic blood flow to the pulmonary circulation must be considered in these patients.




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