Open AccessComparison of Fontan Surgical Options for Patients with Apicocaval Juxtaposition
Author(s) -
Zhenglun Alan Wei,
Camille C. Johnson,
Phillip M. Trusty,
Morgan Stephens,
Wenjun Wu,
Ritchie Sharon,
Balaji Srimurugan,
Brijesh P Kottayil,
Gopalraj Sumangala Sunil,
Mark A. Fogel,
Ajit P. Yoganathan,
Mahesh Kappanayil
Publication year - 2020
Publication title -
pediatric cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.646
H-Index - 71
eISSN - 1432-1971
pISSN - 0172-0643
DOI - 10.1007/s00246-020-02353-8
Subject(s) - medicine , hemodynamics , cardiac surgery , cardiology , ventricle , fontan procedure , vascular surgery , surgery
Apicocaval juxtaposition (ACJ) is a rare form of viscerocardiac malpositions in association with single-ventricle congenital heart defects. The Fontan surgery is the common palliation, and possible surgical options include ipsilateral, contralateral, and intra-atrial conduits. Concerns include lower hemodynamic performances or risks of conduit compression by the cardiac mass. This study investigates the hemodynamics and clinical outcomes of ACJ patients and potential surgical improvements. Ten consecutive ACJ patients were included, along with a reference cohort of ten non-ACJ patients. Magnetic resonance images were acquired at 6 ± 0.6 year follow-up for anatomical analysis and hemodynamic assessments using computational fluid dynamics. Metrics of interest are deformation index (DI), indexed power loss (iPL), and hepatic flow distribution (HFD off ). A "virtual" surgery was performed to explore potential hemodynamic improvements using a straightened conduit. DI for ACJ patients fell within the DI range of non-ACJ patients. Contralateral conduits had insignificantly higher iPL (0.070 [0.032,0.137]) than ipsilateral conduits (0.041 [0.013,0.095]) and non-ACJ conduits (0.034 [0.011,0.061]). HFD off was similar for the ipsilateral (21 [12,35]), contralateral (26 [7,41]), and non-ACJ Fontan conduits (17 [0,48]). Virtual surgery demonstrated that a straightened conduit reduced HFD off and iPL for the contralateral and ipsilateral conduits, potentially leading to improved clinical outcomes. In this limited sample, the hemodynamic performance of ACJ patients was not significantly different from their non-ACJ counterparts. The use of a straightened conduit option could potentially improve patient outcomes. Additionally, the fear of significant compression of conduits for ACJ patients was unsupported.