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Innominate Vein Turn-down Procedure for Failing Fontan Circulation by Hraska, Viktor; Mitchell, Michael E.; Woods, Ronald K.; Hoffman, George M.; Kindel, Steven J.; Ginde, Salil is a Medicine article available to read on EtoBox.

What is Innominate Vein Turn-down Procedure for Failing Fontan Circulation about?

After the Fontan, systemic venous hypertension induces pathophysiologic changes in the lymphatic system that can result in complications of pleural effusion, ascites, plastic bronchitis, and protein losing enteropathy. Advances in medical therapy and novel interventional approaches have not substantially improved the poor prognosis of these complications. A more physiological approach has been developed by decompression of the thoracic duct to the lower pressure common atrium with a concomitant increase of preload. Diverting the innominate vein to the common atrium increases the transport capacity of the thoracic duct, which in most patients enters the circulation at the left subclavian-jugular vein junction. Contrary to the fenestrated Fontan circulation, in which the thoracic duct is drained into the high pressure Fontan circulation, turn down of the innominate vein to the common atrium effectively decompresses the thoracic duct to the lower pressure system with "diastolic suctioning" of lymph. Innominate vein turn-down may be considered for medical-refractory post-Fontan lymphatic complications of persistent chylothorax, plastic bronchitis, and protein losing enteropathy. Prophy

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Author

Hraska, Viktor; Mitchell, Michael E.; Woods, Ronald K.; Hoffman, George M.; Kindel, Steven J.; Ginde, Salil

Publisher

Elsevier Science; Elsevier - WB Saunders; W. B. Saunders Co., Ltd.; Elsevier BV (ISSN 1092-9126)

Published

2020

Language

EN

Field

Medicine (Health Sciences)