Two Cases of Wearing an Implantable Ventricular Assist Device in the Late Postoperative Period after the Fontan Operation Two Cases of Wearing an Implantable Ventricular Assist Device in the Late Postoperative Period after the Fontan Operation

Abstract

Introduction Advancements in perioperative management and operation methods have yielded major improvements in the mid-term postoperative results of Fontan operations. This has progressively revealed various problems such as decreased ventricular function and exercise tolerance capacity over time, along with hindrances to multiple organs throughout the body. We herein report the two cases of wearing an implantable ventricular assist device in the late postoperative period after the Fontan operation. Case Report [Case 1] A 13 year-old female. Her ventricular function gradually decreased following TCPC when she was four years old. She had been hospitalized multiple times due to aggravation of her cardiac insufficiency and she was fitted with a Jarvik2000 following approval of her suitability for a transplant. Her systemic venous pressure prior to the operation was 18 mmHg, CI 1.2. With a heart catheter three years after the operation, it was confirmed that she had recovered to a comparatively satisfactory Fontan circulation, with a systemic venous pressure of 8 mmHg, CI 1.8. [Case 2] An 11 year-old girl. Although she had undergone TCPC at two years of age, it was already indicated at that point that her ventricular function had decreased. A viral infection at the age of eleven further decreased her cardiac function, which required an extracorporeal LVAD-ECMO. After the operation, her physical status has recovered satisfactorily and an HVAD was implanted following approval of her suitability for a transplant. Her systemic venous pressure before the operation was 17 mmHg, CI 1.5. However, with a heart catheter three months after the operation, it was confirmed that she had recovered to a comparatively satisfactory Fontan circulation, with a systemic venous pressure of 10 mmHg, CI 2.4. Summary Failed Fontan circulation is primarily caused by systemic ventricular dysfunction, increases in pulmonary vascular resistance, or by a combination of the two. For cases similar to what we experienced at our facility, we can expect that cardiac assistance can improve Fontan circulation for cases in which pulmonary vascular resistance before failure of the hemodynamics is low and in which increases in pulmonary vascular resistance is reversible.