Document Detail

Clinical results of the staged Fontan procedure in high-risk patients.
MedLine Citation:
PMID:  9647088     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: For high-risk Fontan candidates, the introduction of a bidirectional Glenn shunt before total cavopulmonary connection (a two-staged strategy) may extend the indications for the Fontan procedure. The clinical results of the two-staged and one-staged Fontan procedure were thus reviewed and compared. METHODS: Between November 1991 and July 1996, the two-staged strategy was performed in 40 high-risk Fontan candidates with a mean interval of 17.2 months after introducing the bidirectional Glenn shunt (staged group). We considered a young age (<2 years), high mean pulmonary arterial pressure (> or =20 mm Hg), high pulmonary vascular resistance (> or =3 Wood units), small pulmonary artery (Nakata index <200 mm2/m2), atrioventricular valve incompetence (> or = moderate), distortion of pulmonary artery, anomalous pulmonary venous return, and poor ventricular function as risk factors for the successful completion of Fontan circulation. During the same period, 68 patients underwent the modified Fontan procedure in a one-step fashion (primary group). RESULTS: In the staged group after the bidirectional Glenn shunt, the mean pulmonary arterial pressure and ventricular end-diastolic pressure were both found to have decreased significantly to the same level as those in the primary group, whereas the pulmonary artery demonstrated a significantly smaller size than that in the primary group. Operative morbidity was similar in both groups. Operative mortality was also similar and low in both groups (1.5% in the primary group and 0% in the staged group). CONCLUSIONS: A bidirectional Glenn shunt was found to be a useful interim palliation in high-risk Fontan candidates. This two-staged strategy may extend the operative indications for the Fontan procedure.
M Masuda; H Kado; Y Shiokawa; K Fukae; M Suzuki; E Murakami; H Yasui
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  65     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1998-07-16     Completed Date:  1998-07-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1721-5     Citation Subset:  AIM; IM    
Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Japan.
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MeSH Terms
Age Factors
Arteriovenous Shunt, Surgical
Blood Pressure
Cardiopulmonary Bypass
Child, Preschool
Follow-Up Studies
Fontan Procedure / methods*
Palliative Care
Pulmonary Artery / pathology,  surgery
Pulmonary Veins / abnormalities
Risk Factors
Tricuspid Valve Insufficiency / physiopathology
Vascular Resistance
Vena Cava, Superior / surgery
Ventricular Function / physiology
Ventricular Pressure

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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