PMC6541760_01
Cardiac imaging and physiopathology after Fontan procedure.. Cardiac magnetic resonance (CRM) and schematic diagram of heart physiopathology in patient with tricuspid atresia after Fontan procedure. A) CRM cine_4 chamber view in a 33-years old girl born with tricuspid atresia who underwent palliative direct atrio-pulmonary connection (Fontan procedure) at 6 years of age; B) Schematic diagram of the heart with tricuspid atresia before and after Fontan procedure (copyright license defined by the GNU Free Documentation License, source: https://commons.wikimedia.org/wiki/File:Fontan_procedure.sv). Abbreviations:AVV: atrio-ventricular valve; CRM, Cardiac magnetic resonance; LA: left atrium; RA: right atrium; UVH: univentricular heart.
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A 33-year-old female, who had undergone FP as palliation for a single ventricle anomaly at 6 years of age (Fig. 1), presented alphafetoprotein (AFP) of 3005 ng/mL.
Imaging of hepatocellular carcinoma after Fontan procedure.. Pre-operative images in a 33-years old girl with hepatocellular carcinoma and chronic liver disease after Fontan procedure. A) Computer tomography scan showing hypervascular lesion in segment V on arterial phase; B) Axial fat-suppressed T1-weighted Magnetic resonance imaging with gadoxetic acid administration obtained at 20 min, hepatocellular phase, detecting strong enhancement of the background liver parenchyma, but no uptake in the hepatocellular carcinoma; C) Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography showing increased FDG uptake in the hepatic lesion.
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CLD associated with a 3.4 x 4.5 cm solid hepatic lesion in segment V (Fig. 2). Considering the compensated cardiocirculatory condition (normal systolic heart function, no arrhythmias, good functional capacity) and the CLD grading (Model for End-Stage Liver Disease score: 9, Child-Turcotte-Pugh stage: A) a LLR was planned.
Trocar position for laparoscopic liver resection.. Surgery was performed by the insertion of four trocars: one sovraumbelical for the camera (11 mm), one working trocar in right lateral flank (11 mm), one working trocar in left pararectal position (12 mm) (from which the laparoscopic ultrasound probe was inserted) and one auxiliary trocar in the epigastric region (5 mm). The auxiliary epigastric trocar was inserted to use the aspirator during the liver resection, due to the high risk of bleeding from the cirrhotic liver, and to facilitate the laparoscopic cholecystectomy by holding the fundus of the gallbladder as for standard manner (the cholecystectomy was required due to its close proximity to the hepatic tumor).
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French position and the surgeon stood between the patient's legs. Four trocars (two 11 mm, one 12 mm, one 5 mm) were placed into the abdomen as shown in Fig. 3.