Surgical Alternatives Beyond Fontan: Revisiting the Role of Carotid - Jugular Shunt in Single Ventricle Patients
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Abstract
Single ventricle physiology refers to a group of congenital heart diseases in which only one functional ventricle supports both systemic and pulmonary circulation. These patients often experience chronic cyanosis and are at risk for long-term complications due to abnormal circulation. The current standard of treatment is staged surgical palliation, which includes multiple steps leading to the Fontan procedure, a surgery that allows systemic venous blood to flow directly to the lungs without passing through the heart. However, some patients are not eligible for the Fontan procedure due to unfavorable hemodynamics. In these cases, standard treatment pathways may not be applicable, and alternative approaches must be considered. One such alternative is the carotid-to-jugular vein shunt (CCA–IJV shunt), which aims to lower venous pressure, improve pulmonary blood flow, and reduce the heart’s workload. While evidence is still limited, this technique has been used in selected patients with promising outcomes. This article reviews the physiological rationale, surgical technique, and clinical results of the CCA–IJV shunt, based on both international studies and experiences in Thailand, to explore its role as a palliative option for patients with single ventricle physiology who cannot undergo Fontan completion.
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