Factors associated with mortality or transplantation versus Fontan completion after cavopulmonary shunt for patients with tricuspid atresiaTricuspid atresia with normally related great vessels (TA) is considered the optimal substrate for the Fontan pathway. The factors associated with death or transplantation after cavopulmonary shunt (CPS) are underappreciated. We aimed to determine factors associated with CPS–Fontan interstage death/transplantation versus transition to Fontan in TA.
Commentary: A 3-minute foray into the futureThe year is 2050. Freddy Jones is about to undergo a Fontan operation. Freddy is an unusual patient. Most blastocysts are genetically screened for hypoplastic left heart syndrome, and if detected, a developing patient undergoes either embryological epigenetic modification or fetal intervention, preventing or eliminating the disorder. These techniques are still not globally available, so Freddy was not screened. Thus, Freddy is managed with the older, 3-stage palliation. In preparation for the Fontan, Freddy undergoes cardiac magnetic resonance imaging with complete pressure mapping (diagnostic catheterization became obsolete by 2030).
Another step toward intelligent surgical planningThe applications of computational fluid dynamics (CFD) to cardiovascular medicine and surgery just keep getting better. Trusty and colleagues1 examine a way that CFD could be used to plan “complex” Fontan operations. These patients are those whose anatomy does not “guarantee” a relatively even distribution of hepatic blood flow (HBF) to both lungs with a conventional extracardiac conduit or lateral tunnel. The typical example would be an interrupted inferior vena cava with azygous continuation to a left superior vena cava and a right-sided hepatic veins-to-right pulmonary artery conduit.