Classic Hemi-Fontan and Lateral Tunnel Fontan

Classic Hemi-Fontan and Lateral Tunnel Fontan

THE CLASSIC HEMIFONTAN
PROCEDURE AND LATERAL
TUNNEL FONTAN
Thomas L. Spray MD
Chief, Cardiothoracic Surgery
Alice Langdon Warner Endowed Chair
The Children’s Hospital of Philadelphia
Professor of Surgery
The University of Pennsylvania
HEMIFONTAN PROCEDURE
DISCLOSURES
NONE
HEMIFONTAN PROCEDURE
SURGICAL OPTIONS
• Bidirectional Glenn
• Hemifontan
CHOICE OF SECOND STAGE
DETERMINES
TECHNIQUE OF FONTAN
HEMIFONTAN PROCEDURE
HEMI-FONTAN PROCEDURE
ADVANTAGES:
Maintains SVC-RA connection
• Simplifies completion Fontan
• Antero-posterior caval offset
•
DISADVANTAGES:
Bypass /ischemia/circ. arrest
• Disruption of SA node blood supply
•
HEMIFONTAN PROCEDURE
HEMIFONTAN PROCEDURE
HEMIFONTAN PROCEDURE
HEMIFONTAN PROCEDURE
HEMIFONTAN PROCEDURE
HEMIFONTAN PROCEDURE
HEMIFONTAN PROCEDURE
HEMIFONTAN PROCEDURE
AND COMPLETION
LATERAL TUNNEL FENESTRATED
FONTAN
VIDEO
HEMIFONTAN PROCEDURE
HEMIFONTAN PROCEDURE
HEMIFONTAN PROCEDURE
HEMIFONTAN PROCEDURE
HEMIFONTAN PROCEDURE
HEMIFONTAN PROCEDURE
CONCLUSIONS
• Hemifontan And Bidirectional Glenn Both
Acceptable For Stage 2 Procedure For HLHS
• Choice At Stage 2 Determines Fontan Technique
• Not Clear That Hemifontan Increases Risk Of
Sinus Node Dysfunction
• Hemifontan Provides Anteroposterior Offset For
Fontan That May Improve Hydrodynamic
Function
• Superiority of Extracardiac Over Lateral Tunnel
Fontan Not Yet Determined