Early Results of Extracardiac Fontan Operation.
- Author:
Woong Han KIM
1
;
Do Hyun JUNG
;
Soo Chul KIM
;
Hong Joo JEON
;
Chang Ha LEE
;
Wook Sung KIM
;
Sam Se OH
;
Cheol Hyun CHUNG
;
Chan Young RA
;
Young Thak LEE
;
Young Kwhan PARK
;
Chong Whan KIM
;
Sung Nok HONG
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Puchon-shi, Kyonggi-do, Korea.
- Publication Type:Original Article
- Keywords:
Fontan Operation;
Surgery method
- MeSH:
Allografts;
Aorta;
Arrhythmias, Cardiac;
Arteries;
Cardiac Output, Low;
Chest Tubes;
Chorea;
Crisscross Heart;
Diagnosis;
Drainage;
Female;
Follow-Up Studies;
Fontan Procedure*;
Heart;
Heart Atria;
Heart Septal Defects, Ventricular;
Hemodynamics;
Humans;
Hypertension, Pulmonary;
Isomerism;
Male;
Mortality;
Myocardial Ischemia;
Pliability;
Polypropylenes;
Polytetrafluoroethylene;
Pulmonary Artery;
Pulmonary Valve Stenosis;
Running;
Sutures;
Transplants;
Transposition of Great Vessels;
Tricuspid Atresia;
Vascular Resistance;
Vena Cava, Inferior;
Ventricular Function
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
1998;31(7):650-659
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Between August 1996 and August 1997, 22 patients underwent extracardiac Fontan operations. The basic diagnoses included univentricular heart of the right ventricular type (n=12); univentricular heart of the left ventricular type (n=4); tricuspid atresia (n=4); left isomerism, transposition of great arteries, ventricular septal defect and pulmonary stenosis (n=1); and criss-cross heart with uneven ventricle (n=1). The median age of the 14 men and 8 women was 29 months (range from 21 months to 26 years). Previous procedures included bidirectional cavopulmonary shunt (n=15, interval=15.6+/-3.4 months), Kawashima operation (n=4, interval=37.5+/-20 months), and classic Glenn shunt (n=1, interval=14 years). In 2 patients, extracardiac Fontan operations were done without any previous procedures. A 16-to 22-mm flexible Gore-Tex tube graft (n=18), Hemashield graft (n=3), or, alternatively, a nonvalved aortic allograft (n=1) was cut and anastomosed end-to-end between inferior vena cava and undersurface of pulmonary artery using Gore-Tex or Prolene suture in a running fashion. In risk Fontan patients (n=12), a communication between the extracardiac conduit and the right atrium was constructed. In the most 13 recent patients, the procedures were done without cross-clamping of the aorta and with a beating heart. Operative mortality was 9.1% (n=2). Complications included persistent chest tube drainage for more than 7 days (n=5), chorea (n=2), and low cardiac output (n=1). There were no late deaths. Follow-up echocardiogram (mean: 6 months) demonstrated satisfactory hemodynamic results in the surviving 20 patients. Potential advantages of this technique consist of minimization of surgical manipulation of atrial tissue, reduction or elimination of myocardial ischemia, creationof a uniform and stable inferior vena cava-to-pulmonary artery conduit, and increased flexibility and safety in certain high-risk patients such as those with increased pulmonary vascular resistance, pulmonary hypertension, and impaired ventricular function. Further investigations during a longer follow-up are needed to confirm the intermediate and long-term results, especially the reduction of late atrial arrhythmias.
