Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-18T10:34:08.504Z Has data issue: false hasContentIssue false
  • English
  • Français

Fontan completions over 10 years after Glenn procedures

Published online by Cambridge University Press:  27 March 2013

Koichi Sughimoto ,
Kozo Matsuo ,
Koichiro Niwa ,
Yasutaka Kawasoe ,
Shigeru Tateno ,
Takeaki Shirai ,
Masashi Kabasawa  and
Masanao Ohba
Koichi Sughimoto*
Affiliation:
Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
Kozo Matsuo
Affiliation:
Department of Cardiac Surgery, Chiba Cardiovascular Center, Ichihara, Japan Adult Congenital Heart Disease Program, Chiba Cardiovascular Center, Ichihara, Japan
Koichiro Niwa
Affiliation:
Department of Cardiology, St. Luke International Hospital, Tokyo, Japan
Yasutaka Kawasoe
Affiliation:
Department of Pediatrics, Chiba Cardiovascular Center, Ichihara, Japan
Shigeru Tateno
Affiliation:
Adult Congenital Heart Disease Program, Chiba Cardiovascular Center, Ichihara, Japan Department of Pediatrics, Chiba Cardiovascular Center, Ichihara, Japan
Takeaki Shirai
Affiliation:
Department of Cardiology, St. Luke International Hospital, Tokyo, Japan
Masashi Kabasawa
Affiliation:
Department of Cardiac Surgery, Chiba Cardiovascular Center, Ichihara, Japan
Masanao Ohba
Affiliation:
Department of Cardiac Surgery, Chiba Cardiovascular Center, Ichihara, Japan
*
Correspondence to: K. Sughimoto, Department of Cardiac Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne VIC 3052, Australia. Tel: 03 9345 5200; Fax: 03 9345 6386; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: Despite the broadened indications for Fontan procedure, there are patients who could not proceed to Fontan procedure because of the strict Fontan criteria during the early period. Some patients suffer from post-Glenn complications such as hypoxia, arrhythmia, or fatigue with exertion long after the Glenn procedure. We explored the possibility of Fontan completion for those patients. Methods: Between 2004 and 2010, five consecutive patients aged between 13 and 31 years (median 21) underwent Fontan completion. These patients had been followed up for more than 10 years (10 to 13, median 11) after Glenn procedure as non-Fontan candidates. We summarise these patients retrospectively in terms of their pre-operative physiological condition, surgical strategy, and problems that these patients hold. Results: Pre-operative catheterisation showed pulmonary vascular resistance ranging from 0.9 to 3.7 (median 2.2), pulmonary to systemic flow ratio of 0.3 to 1.6 (median 0.9), and two patients had significant aortopulmonary collaterals. Extracardiac total cavopulmonary connections were performed in three patients, lateral tunnel total cavopulmonary connection in one patient, and intracardiac total cavopulmonary connection in one patient, without a surgical fenestration. Concomitant surgeries were required including valve surgeries – atrioventricular valve plasty in three patients and tricuspid valve replacement in one patient; systemic outflow tract obstruction release – Damus–Kaye–Stansel procedure in two patients and subaortic stenosis resection in one patient; and anti-arrhythmic therapies – maze procedure in two patients, cryoablation in two patients, and pacemaker implantation in two patients. All patients are now in New York Heart Association category I. Conclusion: Patients often suffer from post-Glenn complications. Of those, if they are re-examined carefully, some may have a chance to undergo Fontan completion and benefit from it. Multiple lesions such as atrioventricular valve regurgitation, systemic outflow obstruction, or arrhythmia should be surgically repaired concomitantly.

Keywords

Fontanuniventricular heartadult congenital heart diseaselong-term
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 2 , April 2014 , pp. 290 - 296
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Gatzoulis, MA, Munk, MD, Williams, WG, Webb, GD. Definitive palliation with cavopulmonary or aortopulmonary shunts for adults with single ventricle physiology. Heart 2000; 83: 51–57.Google Scholar
2. Khairy, P, Poirier, N, Mercier, LA. Univentricular heart. Circulation 2007; 115: 800–812.Google Scholar
3. Sughimoto, K, Matsuo, K, Niwa, K, et al. Hemiazygos venous additional pulmonary flow for successful total cavo-pulmonary connection. Congenit Heart Dis 2007; 2: 351–353.Google Scholar
4. Nakata, S, Imai, Y, Takanashi, Y, et al. A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 1984; 88: 610–619.Google Scholar
5. Sughimoto, K, Matsuo, K, Ohba, M. Intracardiac total cavopulmonary connection in an asplenic adult male 12 years after Glenn procedure for total anomalous pulmonary venous return (1b). Eur J Cardiothorac Surg 2012; 42: 182–184.Google Scholar
6. Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.Google Scholar
7. Di Donato, RM, Amodeo, A, di Carlo, DD, et al. Staged Fontan operation for complex cardiac anomalies with subaortic obstruction. J Thorac Cardiovasc Surg 1993; 105: 398–404.Google Scholar
8. Miyaji, K, Nagata, N, Matsui, H, Miyamoto, T, Kitahori, K. Successful Fontan procedure for asplenia with pulmonary atresia and major aortopulmonary collateral arteries. J Thorac Cardiovasc Surg 2003; 126: 1648–1650.Google Scholar
9. Perloff, JK. Congenital heart disease in adults. A new cardiovascular subspecialty. Circulation 1991; 84: 1881–1890.Google Scholar
10. Niwa, K, Perloff, JK, Webb, GD, et al. Survey of specialized tertiary care facilities for adults with congenital heart disease. Int J Cardiol 2004; 96: 211–216.Google Scholar
11. Day, RW, Etheridge, SP, Veasy, LG, et al. Single ventricle palliation: greater risk of complications with the Fontan procedure than with the bidirectional Glenn procedure alone. Int J Cardiol 2006; 106: 201–210.Google Scholar
12. Malhotra, SP, Reddy, VM, Thelitz, S, et al. The role of oxidative stress in the development of pulmonary arteriovenous malformations after cavopulmonary anastomosis. J Thorac Cardiovasc Surg 2002; 124: 479–485.Google Scholar
13. Srivastava, D, Preminger, T, Lock, JE, et al. Hepatic venous blood and the development of pulmonary arteriovenous malformations in congenital heart disease. Circulation 1995; 92: 1217–1222.Google Scholar
14. Shah, MJ, Rychik, J, Fogel, MA, Murphy, JD, Jacobs, ML. Pulmonary AV malformations after superior cavopulmonary connection: resolution after inclusion of hepatic veins in the pulmonary circulation. Ann Thorac Surg 1997; 63: 960–963.Google Scholar
15. Hawkins, JA, Shaddy, RE, Day, RW, Sturtevant, JE, Orsmond, GS, McGough, EC. Mid-term results after bidirectional cavopulmonary shunts. Ann Thorac Surg 1993; 56: 833–837.Google Scholar
16. Robicsek, F, Riopel, DA, Robicsek, LK. Long-term results after cavopulmonary anastomosis. J Thorac Cardiovasc Surg 1991; 101: 740–743.Google Scholar
17. Gray, RG, Altmann, K, Mosca, RS, et al. Persistent antegrade pulmonary blood flow post-Glenn does not alter early post-Fontan outcomes in single-ventricle patients. Ann Thorac Surg 2007; 84: 888–893.CrossRefGoogle Scholar
18. Calvaruso, DF, Rubino, A, Ocello, S, et al. Bidirectional Glenn and antegrade pulmonary blood flow: temporary or definitive palliation? Ann Thorac Surg 2008; 85: 1389–1395.Google Scholar
19. Gérellia, S, Boulitropa, C, Van Steenberghea, M, et al. Bidirectional cavopulmonary shunt with additional pulmonary blood flow: a failed or successful strategy? Eur J Cardiothorac Surg 2012; 42: 513–519.CrossRefGoogle Scholar
20. Grosse-Wortmann, L, Drolet, C, Dragulescu, A, et al. Aortopulmonary collateral flow volume affects early postoperative outcome after Fontan completion: a multimodality study. J Thorac Cardiovasc Surg 2012; 144: 1329–1336.Google Scholar
21. Wong, DJ, Iyengar, AJ, Wheaton, GR, et al. Long-term outcomes after atrioventricular valve operations in patients undergoing single-ventricle palliation. Ann Thorac Surg 2012; 94: 606–613.CrossRefGoogle ScholarPubMed