Innominate vein turn-down procedure: Killing two birds with one stone

Abstract

Feature Editor Note—In an effort to design a perfect thirdstage palliation for our single-ventricle patients, our specialty has been making tremendous efforts to compensate for the well-known disadvantages of a circulatory setting involving a lifelong state of high systemic venous pressure. While we aim to excel at each stage of single-ventricle palliation to prevent a suboptimal Fontan circulation, our focus has indeed sharpened to also understand the variations and impact of the lymphatic system on the outcome of patients before or following third-stage palliation. Novel diagnostic techniques using magnetic resonance imaging aid in visualizing the problems in lymphatic drainage in a standardized manner, whereas novel targeted interventional and surgical techniques by experienced teams offer invaluable solutions for one of the conundrums of the Fontan circulation. Dr Hra ska and expert colleagues graciously contribute to this issue of the Journal with a multidisciplinary invited expert review of their current surgical and interventional strategies to address lymphatic system disturbances in Fontan circulation. The article overviews a clear diagnostic classification of lymphatic pathologies, leading to a decision-making tree. Medical, interventional, and surgical options are discussed in detail. The authors offer an updated cohort with characteristics and outcome of patients who were treated with the innovative innominate vein turn-down procedure. This excellent contribution is accompanied by images and illustrations. The congenital editors thank the authors for this invaluable presentation of their experience.