Document Detail


Intracardiac Fontan procedure for heterotaxy syndrome with complex systemic and pulmonary venous anomalies.
MedLine Citation:
PMID:  19695897     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The extracardiac conduit procedure is widely used for patients with heterotaxy syndrome with complex systemic and pulmonary venous anomalies; however, it lacks conduit-growth potential and requires long-term anticoagulation. We present the intracardiac Fontan procedure, which eliminates the above-mentioned disadvantages.
PATIENTS AND METHODS: Twenty-four patients (mean age, 4.1 years; weight, 13.0 kg) with heterotaxy syndrome underwent intracardiac Fontan operations between March 1995 and March 2008. In each patient, the anomalous systemic venous return with the isolated hepatic vein was redirected to the pulmonary artery using an intra-atrial baffle without obstructing the pulmonary venous pathway; this was accomplished by anterior (n=5), lateral (n=15) or posterior tunnel methods (n=4), depending on the anatomical relationship of the systemic and pulmonary venous pathways.
RESULTS: There was one (4%) in-hospital and two (8%) late deaths in total. Five (21%) patients underwent re-operation for either pulmonary venous obstruction or supraventricular tachycardia. The actuarial 12-year survival was 86% (the Kaplan-Meier survival plot). The freedom from re-operation at 10 years was 77%. Anticoagulation was not required except for two patients (8%) who had prosthetic valves and coagulation disorder. Obstruction of the systemic venous pathway was not observed in any patient; however, five (20%) patients had clinically significant postoperative arrhythmias. At the final follow-up, all survivors were categorised as the New York Heart Association class I.
CONCLUSIONS: Aided by detailed preoperative anatomical and physiological diagnoses, intracardiac Fontan procedures were technically feasible in patients with complex systemic and pulmonary venous anomalies. The specific cardiac anatomy in these patients warranted this procedure; however, taking into consideration the improved outcomes of the modified Fontan procedure, this method should be performed with deliberation.
Authors:
Yuji Naito; Mitsuru Aoki; Kozo Matsuo; Hiromichi Nakajima; Hiroyuki Aotsuka; Tadashi Fujiwara
Related Documents :
16454777 - The case for venous rather than arterial blood gases in diabetic ketoacidosis.
7268207 - Arterial and venous blood sampling in pharmacokinetic studies: propranolol in rabbits a...
8445757 - A rational approach to detection of significant reflux with duplex doppler scanning and...
6829377 - Management of leg ulcers.
22205897 - The role of uterine artery embolization in cervical cancer - single case report.
15826267 - Introduction of permanent cardiac stimulation/defibrillation leads via the retro-pector...
Publication Detail:
Type:  Case Reports; Evaluation Studies; Journal Article     Date:  2009-08-19
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  37     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-03     Completed Date:  2011-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  197-203     Citation Subset:  IM    
Copyright Information:
Copyright 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Affiliation:
Department of Cardiovascular Surgery, Chiba Children's Hospital, Midori-ku, Chiba, Japan. ujinaito@aol.com
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Abnormalities, Multiple / diagnosis,  surgery
Child, Preschool
Dextrocardia / diagnosis,  surgery
Epidemiologic Methods
Female
Fibrinolytic Agents / therapeutic use
Fontan Procedure / methods*
Genetic Diseases, X-Linked / diagnosis,  surgery
Heart Catheterization
Humans
Male
Postoperative Care / methods
Postoperative Complications
Pulmonary Veins / abnormalities,  surgery
Reoperation
Situs Inversus / diagnosis,  surgery
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents

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


Previous Document:  Influence of prosthesis-patient mismatch on left ventricular remodelling in severe aortic insufficie...
Next Document:  Minimised versus conventional cardiopulmonary bypass: outcome of high-risk patients.