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Case Anecdotes, Comments and Opinions| Volume 41, ISSUE 2, P263-265, February 2022

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Heart transplant for failing fontan with situs inversus and aortic aneurysm: Utilization of lateral tunnel fontan pathway for systemic venous reconstruction

  • Mimi Xiaoming Deng
    Affiliations
    Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
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  • Rashmi Nedadur
    Affiliations
    Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada

    Department of Surgery, University of Toronto, Toronto, Canada
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  • S. Lucy Roche
    Affiliations
    Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
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  • David J Barron
    Affiliations
    Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada

    Department of Surgery, University of Toronto, Toronto, Canada
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  • Osami Honjo
    Correspondence
    Reprint requests: Osami Honjo, MD, PhD, Division of Cardiovascular Surgery, Labatt Family Heart Center, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. Tel.: +1 416-813-6420. Fax: +1 416-813-7984.
    Affiliations
    Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada

    Department of Surgery, University of Toronto, Toronto, Canada
    Search for articles by this author
Published:November 06, 2021DOI:https://doi.org/10.1016/j.healun.2021.10.019
Heart transplant for failing fontan with situs inversus and aortic aneurysm: Utilization of lateral tunnel fontan pathway for systemic venous reconstruction
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      Patients with failing Fontan circulation are the most rapidly growing adult congenital heart disease subgroup being referred for heart transplant assessment and represent a highly complex cohort.
      • Crossland DS
      • Jansen K
      • Parry G
      • Harper A
      • Perri G
      • Davidson A
      • et al.
      Outcome following heart transplant assessment in adults with congenital heart disease.
      Heart. 2019; : 1-7
      Optimizing their outcomes requires an expert multidisciplinary team and meticulous surgical planning.
      • Kenny L
      • DeRita F
      • Nassar M
      • Dark J
      • Coats L
      • Hasan A.
      Transplantation in the single ventricle population.
      Ann Cardiothorac Surg. 2018; 7: 152-159
      ,
      • Crossland DS
      • Van De BruaeneSilversides CK
      • Hickey EJ
      • Roche SL
      Can J Cardiol. 2019; 35: 1723-1739
      Technical challenges include multiple previous cardiac surgeries, high-risk redo sternotomy, difficult cannulation, necessity for vascular reconstruction, collateral vessels, and coagulopathy. Situs inversus (SI) with mirror-image systemic venous arrangement introduces additional complexity with such patients often deemed transplant ineligible. This report describes successful heart transplant in an adult patient with a failing lateral tunnel Fontan physiology who had SI with levocardia, and ascending aortic aneurysm. The inferior systemic venous reconstruction was achieved using the lateral tunnel as a baffle to connect the right-sided donor inferior vena cava (IVC) to the left-sided recipient IVC.
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      References

        • Crossland DS
        • Jansen K
        • Parry G
        • Harper A
        • Perri G
        • Davidson A
        • et al.
        Outcome following heart transplant assessment in adults with congenital heart disease.
        Heart. 2019; : 1-7
        View in Article
        • Kenny L
        • DeRita F
        • Nassar M
        • Dark J
        • Coats L
        • Hasan A.
        Transplantation in the single ventricle population.
        Ann Cardiothorac Surg. 2018; 7: 152-159
        View in Article
        • Crossland DS
        • Van De BruaeneSilversides CK
        • Hickey EJ
        • Roche SL
        Can J Cardiol. 2019; 35: 1723-1739
        View in Article
        • Beiras-Fernandez A
        • Daebritz SH
        • Kaczmarek I
        • Kozlik-Feldmann R
        • Tiete AR
        • Reichart B.
        Challenging venous reconstruction and heart transplantation in a patient with viscero-atrial situs inversus and complex congenital heart disease with fontan circulation.
        J Heart Lung Transplant. 2007; 26: 290-292
        View in Article
        • Vallabhajosyula P
        • Komlo C
        • Wallen TJ
        • Olthoff K
        • Pochettino A.
        Combined heart-liver transplant in a situs-ambiguous patient with failed Fontan physiology.
        J Thorac Cardiovasc Surg. 2013; 145: e39-e41
        View in Article

      Article info

      Publication history

      Published online: November 06, 2021

      Identification

      DOI: https://doi.org/10.1016/j.healun.2021.10.019

      Copyright

      Crown Copyright © 2021. Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. All rights reserved.

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