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Late complications associated with the Fontan circulation

Published online by Cambridge University Press:  10 January 2006

Marshall L. Jacobs  and
Glenn Pelletier
Marshall L. Jacobs
Affiliation:
Section of Cardiothoracic Surgery, St. Christopher's Hospital for Children, Drexel University, Philadelphia, Pennsylvania, United States of America
Glenn Pelletier
Affiliation:
Section of Cardiothoracic Surgery, St. Christopher's Hospital for Children, Drexel University, Philadelphia, Pennsylvania, United States of America
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Extract

The recent significant reduction in operative mortality associated with surgical completion of the Fontan circulation is clearly multi-factorial. Better understanding of the fundamental physiological and anatomical issues have led to refinements in operative technique, early neutralization of potential risk factors, widespread use of a staged approach, and selective application of the concept of fenestration or incomplete partitioning. While further reduction of operative mortality is important, and may be anticipated in the future, major emphasis now must be placed on optimizing functional outcome, and understanding and managing the late complications associated with the unique physiology produced by the Fontan circulation.

Keywords

Double inlet ventricleprotein-losing enteropathyfunctionally univentricular circulationatrioventricular valvar atresia
Type
Research Article
Information
Cardiology in the Young , Volume 16 , Supplement S1: Controversies and Challenges in the Management of the Functionally Univentricular Heart , February 2006 , pp. 80 - 84
Copyright
© 2006 Cambridge University Press

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References

Fontan F, Kirklin JW, Fernandez G, et al. Outcome after a “perfect” Fontan operation. Circulation 1990; 81: 1520–1536.Google Scholar
Ohuchi H, Yasuda K, Hasegawa S, et al. Influence of ventricular morphology on aerobic exercise capacity in patients after the Fontan operation. J Am Coll Cardiol 2001; 37: 1967–1974.Google Scholar
Mahle WT, Wernovsky G, Bridges ND, Linton AB, Paridon SM. Impact of early ventricular unloading on exercise performance in preadolescents with single ventricle Fontan physiology. J Am Coll Cardiol 1999; 34: 1637–1643.Google Scholar
Uzark K, Lincoln A, Lamberti JJ, Mainwaring RD, Spicer RL, Moore JW. Neurodevelopmental outcomes in children with Fontan repair of functional single ventricles. Pediatrics 1998; 101: 630–633.Google Scholar
Goldberg CS, Schwartz EM, Brunberg JA, et al. Neurodevelopmental outcome of patients after the Fontan operation: a comparison between children with hypoplastic left heart syndrome and other functional single ventricle lesions. J Pediatr 2000; 137: 646–652.Google Scholar
Wernovsky G, Stiles KM, Gauvreau K, et al. Cognitive development after the Fontan operation. Circulation 2000; 102: 883–889.Google Scholar
du Plessis AJ, Chang AC, Wessel DL, et al. Cerebrovascular accidents following the Fontan operation. Pediatr Neurol 1995; 12: 230–236.Google Scholar
Monagle P, Cochrane A, McCrindle B, Benson L, Williams W. Andrew M. Editorial: thromboembolic complications after Fontan procedures – the role of prophylactic anticoagulation. J Thorac Cardiovasc Surg 1998; 115: 493–498.Google Scholar
Jahangiri M, Ross DB, Redington AN, Lincoln C, Shinebourne EA. Thromboembolism after the Fontan procedure and its modifications. Ann Thorac Surg 1994; 58: 1409–1414.Google Scholar
Rauch R, Ries M, Hofbeck M, Buheitel G, Singer H, Klinge J. Hemostatic changes following the modified Fontan operation (total cavopulmonary connection). Throm Haemost 2000; 83: 678–682.Google Scholar
Monagle P, Andrew M. Coagulation abnormalities after Fontan procedures. J Thorac Cardiovasc Surg 1998; 115: 732.Google Scholar
Jacobs ML, Pourmoghadam KK, Geary EM, et al. Fontan's operation: Is aspirin enough? Is Coumadin too much? Presented in the Annual Meeting of the Society of Thoracic Surgeons, January 30, 2001. New Orleans, LA.
Freedom RM, Sondheimer H, Dische MR, Rowe RD. Development of “subaortic stenosis” after pulmonary artery banding for common ventricle. Am J Cardiol 1977; 39: 78–83.Google Scholar
Finta KM, Beckman RH, Lupinetti FM, Bove EL. Systemic ventricular outflow obstruction progresses after Fontan operation. Ann Thorac Surg 1994; 58: 1108–1113.Google Scholar
Jonas RA, Castaneda AR, Lang P. Single ventricle complicated by subaortic stenosis: surgical options in infancy. Ann Thorac Surg 1985; 39: 361–366.Google Scholar
Jacobs ML, Rychik J, Donofrio MT, et al. Avoidance of subaortic obstruction in staged management of single ventricle. Ann Thorac Surg 1995; 60: S543–S545.Google Scholar
Karl TR, Watterson KG, Sano S, Mee RBB. Operations for subaortic stenosis in univentricular hearts. Ann Thorac Surg 1991; 52: 420–427.Google Scholar
Lacour-Gayet F, Serraf A, Fermont L, et al. Early palliation of univentricular hearts with subaortic stenosis and ventriculoarterial discordance. J Thorac Cardiovasc Surg 1992; 104: 1238–1245.Google Scholar
Durongpisitkul K, Porter CJ, Cetta F, et al. Predictors of early- and late-onset supraventricular tachyarrhythmias after Fontan operation. Circulation 1998; 98: 1099–1107.Google Scholar
Fishberger SB, Wernovsky G, Gentles TL, et al. Factors that influence the development of atrial flutter after the Fontan operation. J Thorac Cardiovasc Surg 1997; 113: 80–86.Google Scholar
Paul T, Ziemer G, Luhmer L, Bertram H, Hecker H, Kallfelz HC. Early and late atrial dysrhythmias after modified Fontan operation. Pediatr Med Chir 1998; 20: 9–11.Google Scholar
Cohen MI, Bridges ND, Gaynor JW, et al. Modifications to the cavopulmonary anastomosis do not eliminate early sinus node dysfunction. J Thorac Cardiovasc Surg 2000; 120: 891–900.Google Scholar
Marcelletti CF, Hanley FL, Mavroudis C, et al. Revision of previous Fontan connections to total extracardiac cavopulmonary anastomosis: A multicenter experience. J Thorac Cardiovasc Surg 2000; 119: 340–346.Google Scholar
Mavroudis C, Deal BJ, Backer CL, Johnsrude CL. The favorable impact of arrhythmia surgery on total cavopulmonary artery Fontan conversion. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 1999; 2: 143–156.Google Scholar
Kawahira Y, Uemura H. Yagihara T, Yoshikawa Y, Kitamura S. Renewal of the Fontan circulation with concomitant surgical intervention for atrial arrhythmia. Ann Thorac Surg 2001; 71: 919–921.Google Scholar
Feldt RH, Driscoll DJ, Offord KP, Cha RH, Perrault J, Shaff HV, et al. Protein-losing enteropathy after the Fontan operation. J Thorac Cardiovasc Surg 1996; 112: 672–680.Google Scholar
Merterns L, Hagler DJ, Sauer U, Somerville U, Gewillig M. Protein-losing enteropathy after the Fontan operation: an international multicentric study. In: Yasuharu I, Kazuo M (eds). Proceedings of the 2nd World Congress of Pediatric Cardiology and Cardiac Surgery. 2nd edn. Futura Publishing Company, New York, 1998, pp 34–36.
Yang SG, Rychik J. Mesenteric blood flow patterns after Fontan operation: a link to the development of protein-losing enteropathy? Circulation 1999; 100 (Suppl I): I-399.Google Scholar
Jacobs M, Rychik J, Byrum C, Norwood WI. Protein-losing enteropathy after the Fontan operation: Resolution after baffle fenestration. Ann Thorac Surg 1996; 61: 206–208.Google Scholar
Warnes C, Feldt R, Hagler D. Protein-losing enteropathy after the Fontan operation: successful treatment by percutaneous fenestration of the atrial septum. Mayo Clin Proc 1996; 71: 378–379.Google Scholar
Cohen MI, Rhodes LA, Wernovsky G, Gaynor JW, Spray TL, Rychik J. Atrial pacing: an alternative treatment for protein- losing enteropathy after the Fontan operation. J Thorac Cardiovasc Surg 2001; 121: 582–583.Google Scholar