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J Thorac Cardiovasc Surg 2003;125:421-423
© 2003 The American Association for Thoracic Surgery

Brief Communications

Unintended right-to-left shunt after Fontan operation: Consequence of unligated vertical vein in a child with total anomalous pulmonary venous drainage, single ventricle, and heterotaxy

David Mishaly, MD, Julius Hegesh, MD, Mira Frand, MD, Aram Smolinsky, MD, Gabriel Amir, MD Tel Aviv, Israel

From the Department of Pediatric Cardiology and Cardiac Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Received for publication June 10, 2002. Accepted for publication July 1, 2002. Address for reprints: David Mishaly, MD, Department of Congenital and Pediatric Cardiac Surgery, Haim Sheba Medical Center, Tel Hashomer 52621, Israel (E-mail:

The first 20% of the full text of this article appears below.

Ligation of the vertical vein (VV) during the correction of total anomalous pulmonary venous drainage (TAPVD) is controversial.Go Go 1-3 Most surgeons usually ligate or divide the VV, but others support a potential benefit in leaving it patent to serve as a possible vent for relatively hypoplastic, noncompliant left heart chambers.Go Go 1,2 The fate of an unligated VV late after correction of a TAPVD is unclear; both no flowGo Go 1,4 and patent veins with considerable left-to-right shuntingGo Go 3,5 have been reported. We report a rare case of persistent cyanosis after a Fontan procedure in a patient with a VV left open after correction of infracardiac TAPVD and emphasize the importance of VV ligation in this special setting of single ventricle and TAPVD.

Clinical summary

A 3.5-year-old girl was seen with persistent cyanosis after completion of the Fontan operation. She had a diagnosis from birth of infracardiac TAPVD, a double-outlet right ventricle, transposition of the great arteries, mitral atresia, and heterotaxy with right isomerism and asplenia. Correction of total . . . [Full Text of this Article]






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