Extracorporeal membrane oxygenation in curing a young man after modified Fontan operation:A case report

BACKGROUND The Fontan operation is the only treatment option to change the anatomy of the heart and help improve patients’ hemodynamics.After successful operation,patients typically recover the ability to engage in general physical activity.As a better ventilatory strategy,extracorporeal membrane oxygenation(ECMO) provides gas exchange via an extracorporeal circuit,and is increasingly being used to improve respiratory and circulatory function.After the modified Fontan operation,circulation is different from that of patients who are not subjected to the procedure.This paper describe a successful case using ECMO in curing influenza A infection in a young man,who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago.The special cardiac structure and circulatory characteristics are explored in this case.CASE SUMMARY We report a successful case using ECMO in curing influenza A infection in a 23-year-old man,who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago.The man was admitted to the intensive care unit with severe acute respiratory distress syndrome as a result of influenza A infection.He was initially treated by veno-venous(VV) ECMO,which was switched to veno-venous-arterial ECMO(VVA ECMO) 5 d later.As circulation and respiratory function gradually improved,the VVA ECMO equipment was removed on May 1,2018.The patient was successfully withdrawn from artificial ventilation on May 28,2018 and then discharged from hospital on May 30,2018.CONCLUSION After the modified Fontan operation,circulation is different compared with that of patients who are not subjected to the procedure.There are certainly many differences between them when they receive the treatment of ECMO.Due to the special cardiac structure and circulatory characteristics,an individualized liquid management strategy is necessary and it might be better for them to choose an active circulation support earlier.

Results of Fontan in Patients with Apicocaval Juxtaposition or/and Separated Hepatic Venous Drainage

Objective:Modifications of the Fontan operation,which are also known as total cavopulmonary connection(TCPC),are widely applied for patients with functionally univentricular hearts(FUH).Herein,we summed up the different surgical pathways and clinical outcomes in FUH patients with apicocaval juxtaposition(ACJ)or/and separated hepatic venous(SHV)drainage.Methods:Between January 2009 and December 2019,123 patients who undergone TCPC in our institute were included in this retrospective study.We have included 70 patients with ACJ(Group 1)and 53 patients with SHV(Group 2).Moreover,Group 2 included 17 cases combing with ACJ(32.1%).In Group 1,three different TCPC methods were conducted.While 45 cases were conducted with the extracardiac conduit-TCPC(EC-TCPC)method,24 cases used the intracardiac conduit-TCPC(IC-TCPC)method,and only one case used the lateral tunnel-TCPC(LT-TCPC).In Group 2,four TCPC methods were conducted on patients.Forty cases used the EC-TCPC-common open technique,6 cases with IC-TCPC technique,4 cases with LT-TCPC,and 3 cases with intra-extracardiac conduit-TCPC(IEC-TCPC).Results:There were 7 patients in Group 1 and 14 patients in Group 2 who required early re-operation during hospitalization(p<0.05).Postoperative mean pulmonary artery pressure(mPAP)greater than 15 mmHg emerged as a predictor for early re-operation(p<0.01)and early death(p<0.001)in univariate analysis.Conclusions:TCPC can be performed in these patients and shows beneficial results.Under the Fontan principle of connecting systemic venous to the pulmonary vasculature unimpededly,surgeons should carefully evaluate three components when choosing for the surgical technique:The distance between inferior vena cava(IVC)and the apex;the site of the vertebrae relative to the ACJ;the distance between ACJ and SHV if coexisting.However,the technique should be altered when the postoperative mPAP was greater than 15 mmHg.