Asian Cardiovasc Thorac Ann 2001;9:141
© 2001 Asia Publishing EXchange Pte Ltd
Invited Commentary
Antonio F Corno, MD
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Department of Cardiovascular Surgery, University Hospital of Vaud, Rue de Bugnon 46, Lausanne CH-1011, Switzerland
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This case report deserves the attention of all readers involved in the care of children with complex congenital heart defects, for the following reasons: the rarity of the association of complex congenital heart defects; the surgical challenge in terms of decision-making and technical complexity, required by the above association; the fact that a similar anatomic situation on either side of the pulmonary venous connection can be encountered when planning or performing a cavopulmonary connection; the solution found and accomplished by the authors; the good early clinical result obtained; the very honest description of the surprise on discovery in the operating room of the unexpected anatomy; the honest admission of the "not very good" palliation received by the child; and the extensive list of real and potential problems left open by this unusual type of surgical palliation.
Of course the available surgical alternatives, particularly avoidance of acquired disconnection of the pulmonary arteries, should be taken into consideration when facing a similar situation. For the long-term results of any type of cavopulmonary connection, it is vital to avoid dis-connecting the pulmonary arteries in order to leave both lungs exposed to the hepatic venous blood; this precaution could maintain a minimum risk of developing pulmonary arteriovenous fistulae.
Finally, with regard to the future plans for this particular case, any constructive proposal has to evaluate all the potential surgical options in order to complete the cavopulmonary connection (inferior vena cava to the pulmonary circulation) but with reconstruction of the pulmonary arterial continuity.
