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David L.S. Morales
Iki Adachi
Jeffrey S. Heinle
Charles D. Fraser, Jr.
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J Thorac Cardiovasc Surg 2011;142:e138-e140
© 2011 The American Association for Thoracic Surgery

Brief Clinical Report

A new era: Use of an intracorporeal systemic ventricular assist device to support a patient with a failing Fontan circulation

David L.S. Morales, MD*, Iki Adachi, MD, Jeffrey S. Heinle, MD, Charles D. Fraser, Jr., MD

Congenital Heart Surgery Division, Texas Children’s Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex

Received for publication December 17, 2010; revisions received April 18, 2011; accepted for publication May 23, 2011.

* Address for reprints: David L. S. Morales, MD, Division of Congenital Heart Surgery, Texas Children’s Hospital, 6621 Fannin St, WT19345H, Houston, TX 77030. (Email: dlmorale@texaschildrens.org).

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


   Introduction
 
Worldwide experience with ventricular assist device (VAD) support in patients with univentricular physiology has been very limited. In particular, the use of a long-term continuous-flow implantable VAD has never been described. We report the successful application of an intracorporeal systemic ventricular assist device (SVAD), the HeartMate II (Thoratec Corporation, Pleasanton, Calif), in an adolescent with a failing Fontan circulation and protein-losing enteropathy (PLE).


   Clinical Summary
 
The patient is a 15-year-old boy (body surface area, 1.5 m2) with double-outlet right ventricle, mitral atresia, and a systemic right ventricle. He underwent staged palliation culminating in a fenestrated lateral Fontan operation at 3 years old. Although he did well for many years, his condition began to deteriorate with increasing dyspnea on exertion, peripheral pitting edema, and hepatomegaly with ascites. PLE was diagnosed (serum albumin, 2.6 g/dL; prealbumin, 9.7 mg/dL). Echocardiogram revealed severely depressed systolic ventricular function with significant tricuspid regurgitation. In preparation for cardiac transplantation, a cardiac catheterization was performed. After induction of positive-pressure ventilation, he had several periods of cardiac arrest . . . [Full Text of this Article]






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