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Novel surgical approach ‘intrapulmonary-artery septation’ for Fontan candidates with unilateral pulmonary arterial hypoplasia or pulmonary venous obstruction

Department of Cardiovascular Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660 Japan

*Corresponding author. Tel.: +81-54-247-6251; fax: +81-54-247-6259.

E-mail address: sakamoto{at}jun.ncvc.go.jp (K. Sakamoto).

It is difficult to manage patients with single ventricular physiology and unbalanced pulmonary arteries. Since 1998, we started a novel approach [Intrapulmonary-artery Septation (IPAS)] to improve the result for those with severe unbalanced pulmonary arteries consisting of a well-grown pulmonary artery and an inadequately-grown pulmonary artery. The inadequately-grown pulmonary artery includes severe pulmonary arterial hypoplasia and pulmonary venous obstruction. This approach is based on the following concepts: (1) A reliable blood source should be secured to recover the inadequately-grown pulmonary artery; (2) Wasteful volume-load should be prevented for the heart; (3) Long stenosis or non-confluence of pulmonary artery should be avoided. IPAS primarily consists of (A) a Glenn shunt; (B) a systemic-pulmonary artery shunt; and (C) a septation-patch. Both (A) and (B) are adjoined on a well-grown pulmonary artery, and (C) is placed between (A) and (B). PAS brings two separate blood flows of a Glenn shunt to the well-grown side and SPS on the inadequately-grown side. IPAS was performed in 20 patients. Seventeen reached the Fontan operation. Eleven underwent postoperative catheterization and seven had acceptable-balanced pulmonary blood flow distribution. IPAS can pilot more complicated cases having severe unbalanced pulmonary arteries to the Fontan circulation.

Key Words: Fontan operation; Glenn shunt; Bidirectional Glenn shunt; Systemic-pulmonary arterial shunt; Pulmonary arterial hypoplasia; Pulmonary venous obstruction

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