Novel approaches to direct atrial access after extracardiac fontan palliation

Victor “Sam” Lucas

doi:10.1002/ccd.27218

Severe conduit stenosis in a patient with Fontan circulation with a Y-shaped Dacron conduit

Cardiology in the Young ◽

10.1017/s1047951121001293 ◽

2021 ◽

pp. 1-3

Author(s):

Daiji Takajo ◽

Preetha L. Balakrishnan ◽

Sanjeev Aggarwal

Keyword(s):

Energy Loss ◽

Polyethylene Terephthalate ◽

Rare Complication ◽

Flow Distribution ◽

Fontan Circulation ◽

Distribution Data ◽

Extracardiac Fontan ◽

Fontan Palliation

Abstract Conduit stenosis is a major, albeit rare, complication following the Fontan palliation. A single-baffle conduit with polytetrafluoroethylene is widely used for an extracardiac type Fontan palliation. A polyethylene terephthalate conduit (Dacron) is sometimes used for the conduit when more flexibility is required. A Y-shaped conduit is rarely used, but it may reduce the energy loss and achieve better hepatic flow distribution. Data on the long-term patency and complications when using a Y-shaped Dacron conduit is lacking. We report a case of a severely stenotic Y-shaped Dacron conduit in a patient who underwent extracardiac Fontan palliation.

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Outcomes among adult survivors of total cavopulmonary Fontan palliation for single ventricle

Heart ◽

10.1136/heartjnl-2021-319760 ◽

2021 ◽

pp. heartjnl-2021-319760

Author(s):

Christopher Anigwe ◽

Vidhushei Yogeswaran ◽

Anita Moon-Grady ◽

Sophie McAllister ◽

Anika Aggarwal ◽

...

Keyword(s):

Single Ventricle ◽

Adverse Outcome ◽

Survival Rates ◽

Adult Survivors ◽

Adverse Outcomes ◽

Protein Losing Enteropathy ◽

Tertiary Centre ◽

Lateral Tunnel ◽

Extracardiac Fontan ◽

Fontan Palliation

ObjectiveThis tertiary centre study aims to identify factors associated with adverse outcomes in adult survivors with total cavopulmonary connection (TCPC) Fontan palliation for single ventricle.MethodsThis retrospective review of medical records identified adult (≥18 years) survivors of TCPC Fontan palliation who were followed at a single tertiary centre between 1 January 2000 and 1 July 2019. Adverse outcomes were defined as arrhythmia, pacemaker/implantable cardioverter defibrillator placement, liver cirrhosis, protein losing enteropathy, hospitalisation for heart failure, thromboembolic complication and/or death.Results160 adult TCPC patients met the inclusion criteria: 117 (73.1%) extracardiac and 43 (26.9%) lateral tunnel. The median (IQR) duration of follow-up since TCPC palliation was 17.5 (11.8–21.3) years. An adverse outcome occurred in 87 (54.4%) patients. Adverse outcome-free survival rates at 10, 20 and 25 years post TCPC were 89% (95% CI 82% to 93%), 60% (95% CI 50% to 69%) and 24% (95% CI 15% to 35%), respectively. On multivariate analysis, extracardiac Fontan (HR 2.21, 95% CI 1.20 to 4.08, p=0.011) was observed to be an independent risk factor for adverse outcomes after adjusting for age, race, morphology of the systemic ventricle and history of fenestration.ConclusionsIn this single-centre retrospective study of adult survivors of TCPC palliation, extracardiac Fontan was associated with an increased hazard for adverse outcomes. This finding could guide clinicians in developing risk modification strategies and management decisions to improve long-term outcomes in these patients.

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Simplified Approach for Ablation of Nodal Reentrant Tachycardia in a Patient With Tricuspid Atresia and Extracardiac Fontan Palliation

Revista Española de Cardiología (English Edition) ◽

10.1016/j.rec.2012.08.005 ◽

2013 ◽

Vol 66 (4) ◽

pp. 314-316

Author(s):

Eduardo Arana-Rueda ◽

Alonso Pedrote ◽

Juan Manuel Durán-Guerrero ◽

José Santos de Soto

Keyword(s):

Tricuspid Atresia ◽

Reentrant Tachycardia ◽

Simplified Approach ◽

Extracardiac Fontan ◽

Fontan Palliation

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Transconduit puncture for catheter ablation of atrial tachycardia in a patient with extracardiac Fontan palliation

Heart Rhythm ◽

10.1016/j.hrthm.2009.10.037 ◽

2010 ◽

Vol 7 (3) ◽

pp. 413-416 ◽

Cited By ~ 39

Author(s):

Amish S. Dave ◽

Jamil Aboulhosn ◽

John S. Child ◽

Kalyanam Shivkumar

Keyword(s):

Catheter Ablation ◽

Atrial Tachycardia ◽

Extracardiac Fontan ◽

Fontan Palliation

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Novel Approaches to Low-Voltage Scanning Electron Microscopy

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100180586 ◽

1990 ◽

Vol 48 (1) ◽

pp. 366-367

Author(s):

Arthur V. Jones

Keyword(s):

Electron Microscopy ◽

Scanning Electron Microscopy ◽

Low Voltage ◽

Electron Optics ◽

Current Interest ◽

New Concepts ◽

Opportune Time ◽

Novel Approaches ◽

Voltage Scanning ◽

Scanning Electron

In comparison with the developers of other forms of instrumentation, scanning electron microscope manufacturers are among the most conservative of people. New concepts usually must wait many years before being exploited commercially. The field emission gun, developed by Albert Crewe and his coworkers in 1968 is only now becoming widely available in commercial instruments, while the innovative lens designs of Mulvey are still waiting to be commercially exploited. The associated electronics is still in general based on operating procedures which have changed little since the original microscopes of Oatley and his co-workers.The current interest in low-voltage scanning electron microscopy will, if sub-nanometer resolution is to be obtained in a useable instrument, lead to fundamental changes in the design of the electron optics. Perhaps this is an opportune time to consider other fundamental changes in scanning electron microscopy instrumentation.

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