| Total cavopulmonary connections in children with a previous Norwood procedure. | |
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MedLine Citation:
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PMID: 11383797 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Outcomes of the Fontan operation in children initially palliated with the modified Norwood procedure are incompletely defined. METHODS: From August 1993 to January 2000, 45 patients (mean age 2.6 +/- 1.1 years, weight 12.7 +/- 2.8 kg) who were palliated with staged Norwood procedures (hypoplastic left heart syndrome, n = 32; nonhypoplastic left heart syndrome, n = 13) underwent a modified Fontan operation. Preoperative features included moderate/severe atrioventricular valve regurgitation (n = 5, 11%), reduced ventricular function on echocardiography in 11 patients, McGoon index 1.56 +/- 0.38, and pulmonary artery distortion in 18 patients (40%). RESULTS: A lateral tunnel (n = 16) or an extracardiac conduit (n = 29) connection with fenestration in 38 patients (84%) was used. Concomitant procedures included pulmonary artery reconstruction (n = 24, 53%), atrioventricular valve repair (n = 4, 9%) or replacement (n = 1). Before Fontan, 12 patients (27%) had an intervention to address neoaortic obstruction, and 7 patients required balloon dilation/stenting of the left (n = 5) or right pulmonary artery (n = 5). Intraoperatively, left (n = 5) or right pulmonary artery (n = 1) stenting was performed in 5 patients (11%). On follow-up, 8 patients required additional interventional procedures to address left pulmonary artery narrowing (n = 5), or venous (n = 5) or arteriopulmonary collaterals (n = 1). Perioperative mortality was 4.4% (n = 2). There were 2 late deaths at a mean follow-up of 39 +/- 20 months. CONCLUSIONS: In relatively high-risk patients, midterm results of the Fontan operation for children initially palliated with the Norwood procedure were good. Combined interventional-surgical treatment algorithms can lead to improved outcomes. |
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Authors:
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A Azakie; B W McCrindle; L N Benson; G S Van Arsdell; J L Russell; J G Coles; D Nykanen; R M Freedom; W G Williams |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 71 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2001 May |
Date Detail:
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Created Date: 2001-05-31 Completed Date: 2001-06-14 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1541-6 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, The Hospital For Sick Children, University of Toronto School of Medicine, Ontario, Canada. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Child Child, Preschool Female Follow-Up Studies Fontan Procedure* Heart Bypass, Right / methods* Heart Defects, Congenital / mortality, surgery* Hemodynamics / physiology Hospital Mortality Humans Hypoplastic Left Heart Syndrome / mortality, surgery* Infant Male Palliative Care Postoperative Complications / mortality, surgery Reoperation Survival Rate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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