Design and Application of Glenn Fenestration - A Novel Hybrid Fontan Pretreatment

Dawei Jin, Qiang Zhao, Jun Du, Qian Wang, Jinlong Liu, Weihong Xu, Jie Bai, Yumin Zhong, Jinfen Liu, Deling Kong, Yanan Lu, Haibo Zhang and Meng Yin

Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, China
State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials, China
Department of Radiology, Shanghai Children's Medical Center, China
Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, China
Department of Operating Room, Shanghai Children's Medical Center, School of Medicine, China
Department of Anesthesiology, Shanghai Children’s Medical Center, School of Medicine, China
Department of Pediatric Cardiothoracic Surgery, Shanghai Xinhua Hospital, China

^*Correspondance to: Yanan Lu 

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Abstract:

Objective: To reduce the difficulty of the second stage of intervention in Hybrid Fontan surgery, we designed a novel Glenn fenestration.Surgical
Design: Through the Right Atrial (RA) incision, two Gore-Tex patches with a fenestration in the middle were sewn in the RA to “close” the Superior Vena Cava (SVC)-RA junction and RA-Inferior Vena Cava (IVC) junction. The fenestration of the SVC-RA patch played a role in decompression of SVC to reduce Central Venous Pressure (CVP). Meanwhile, it could be an entrance for stent placement, avoiding needle acupuncture and laser burning. The fenestration of the RA-IVC patch not only introduced the blood flow from the IVC into the RA, but also supported the fixation of the stent.Results: During the hospitalization, the postoperative blood oxygen saturation (SaO2) of both children maintained above 85% and the CVP remained at 15 mmHg and 14 mmHg, respectively. Long-term follow-up after discharge, these two children were with a good quality of life.Conclusion: We modified the traditional Glenn treatment. It is suitable for some favorable patients especially for those with high CVP and can reduce the technical threshold of the intervention.

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Cite the Article:

Jin D, Zhao Q, Du J, Wang Q, Liu J, Xu W, et al. Design and Application of Glenn Fenestration - A Novel Hybrid Fontan Pretreatment. Ann Clin Case Rep. 2019; 4: 1575.