Document Detail


Importance of acquired systemic-to-pulmonary collaterals in the Fontan operation.
MedLine Citation:
PMID:  10509993     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Children with chronic cyanotic heart disease often develop systemic-to-pulmonary collateral arteries that can be deleterious at the time of a Fontan procedure due to excessive pulmonary blood flow. We therefore occlude all significant collaterals during cardiac catheterization. METHODS: From June 1993 to May 1998, 93 children aged 1.5 to 15.8 years (median 2.5 years) underwent a fenestrated lateral tunnel Fontan procedure. Eighty-nine (96%) had a previous bidirectional Glenn anastomosis, including 31 (33%) with a Norwood procedure. RESULTS: Preoperatively, 33 children (35%) required occlusion of 1 to 11 (mean 3.6) collateral vessels. Two of the three perioperative deaths (operative survival 97%) were due to excessive pulmonary blood flow from unrecognized collaterals in one and uncontrollable collaterals in the other. Postoperatively, 19 children (20%) required coil occlusion of 1 to 21 (mean 5.6) collaterals for elevated pulmonary artery pressures, heart failure, or prolonged chest tube drainage. Duration of inotropic support, postoperative ventilation, intensive care unit stay, and postoperative hospitalization were all significantly longer in the patients who had postoperative occlusion of collaterals. On follow-up of 2 to 67 months (mean 35 months), there have been four late deaths (two infections, two heart failures); 6 patients underwent successful cardiac transplantation for refractory heart failure. All 8 patients with ventricular failure required occlusion of significant collaterals postoperatively. CONCLUSIONS: Hemodynamically significant collaterals are not uncommon in Fontan candidates, and aggressive control can result in good operative and medium-term survival. After the Fontan, significant collaterals may be a marker for eventual cardiac failure because 8 of 18 patients requiring postoperative coils went on to transplantation or died of heart failure.
Authors:
K R Kanter; R N Vincent; A A Raviele
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  68     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-15     Completed Date:  1999-10-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  969-74; discussion 974-5     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardio-Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA. kkanter@emory.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Cardiotonic Agents / therapeutic use
Child
Child, Preschool
Collateral Circulation*
Embolization, Therapeutic*
Fontan Procedure* / mortality
Heart Catheterization
Heart Defects, Congenital / physiopathology,  surgery*
Humans
Infant
Length of Stay
Postoperative Care
Preoperative Care
Pulmonary Circulation*
Respiration, Artificial
Survival Rate
Chemical
Reg. No./Substance:
0/Cardiotonic Agents

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


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