Document Detail

Do we need fenestration when performing two-staged total cavopulmonary connection using an extracardiac conduit?
MedLine Citation:
PMID:  19351688     Owner:  NLM     Status:  MEDLINE    
Between August 1999 and December 2007, 72 consecutive patients with single ventricle physiology underwent a modified Fontan procedure after a bidirectional Glenn shunt using an extracardiac polytetrafluoroethylene conduit without fenestration. Nitric oxide gas inhalation was commenced just after cardiopulmonary bypass together with intravenous phosphodiesterase III inhibitor administration. After oral intake was started, pulmonary vascular dilators such as beraprost, sildenafil, bosentan were given orally according to amount of chest drainage and patient's condition. After discharge, oxygen therapy at home was continued for three months. No hospital death occurred after surgery. All patients were followed by our institute and follow-up period was 44.2+/-26 (36-106.8) months. One late death occurred during this follow-up period after re-operation. Cardiac catheterization after the Fontan completion showed transpulmonary gradient of 5.9+/-2.4 mmHg, systemic output of 3.4+/-2.1 l/min m2. Arterial oxygen saturation (SaO(2)) at the latest outpatient visit was 94.4+/-3.8%. According to our clinical experience with two-staged total cavopulmonary connection using an extracardiac conduit without fenestration, fenestration in the Fontan circuit is not necessary when performing the Fontan completion. Two-staged extracardiac total cavopulmonary connection without fenestration can be satisfactorily completed with the aid of pulmonary vasodilation therapy.
Yorikazu Harada; Shunji Uchita; Takahiko Sakamoto; Mitsuhiro Kimura; Kentaro Umezu; Kiyohiro Takigiku; Satoshi Yasukouchi
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Publication Detail:
Type:  Journal Article     Date:  2009-04-07
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  9     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-23     Completed Date:  2009-08-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  50-4; discussion 54     Citation Subset:  IM    
Department of Cardiovascular Surgery and Cardiology, Nagano Children's Hospital, 3100 Toyoshina, Azumino, Nagano 399-8288, Japan.
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MeSH Terms
Administration, Inhalation
Administration, Oral
Cardiopulmonary Bypass
Child, Preschool
Combined Modality Therapy
Follow-Up Studies
Fontan Procedure* / adverse effects,  mortality
Heart Bypass, Right / adverse effects,  instrumentation*,  mortality
Heart Catheterization
Heart Defects, Congenital / drug therapy,  mortality,  physiopathology,  surgery*
Injections, Intravenous
Kaplan-Meiers Estimate
Nitric Oxide / administration & dosage
Oxygen Inhalation Therapy
Phosphodiesterase Inhibitors / administration & dosage
Prosthesis Design
Pulmonary Artery / drug effects,  physiopathology,  surgery*
Time Factors
Treatment Outcome
Vasodilator Agents / administration & dosage
Reg. No./Substance:
0/Phosphodiesterase Inhibitors; 0/Vasodilator Agents; 10102-43-9/Nitric Oxide; 9002-84-0/Polytetrafluoroethylene
Comment In:
Interact Cardiovasc Thorac Surg. 2009 Jul;9(1):55   [PMID:  19546294 ]

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

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