Total cavopulmonary anastomosis versus conventional modified Fontan procedure

1991 ◽  
Vol 52 (2) ◽  
pp. 189-196 ◽  
Author(s):  
Jeffrey M. Pearl ◽  
Hillel Laks ◽  
Darryl G. Stein ◽  
Davis C. Drinkwater ◽  
Barbara L. George ◽  
...  
Keyword(s):  
Fontan Procedure ◽  
Cavopulmonary Anastomosis ◽  
Total Cavopulmonary Anastomosis

Total Cavopulmonary Anastomosis: Selection Criteria Related to Postoperative Results

1993 ◽  
Vol 41 (01) ◽  
pp. 28-33 ◽  
Author(s):  
M. Hofbeck ◽  
H. Singer ◽  
J. Scharf ◽  
F. Wild ◽  
M. Ries ◽  
...  
Keyword(s):  
Selection Criteria ◽  
Postoperative Results ◽  
Cavopulmonary Anastomosis ◽  
Total Cavopulmonary Anastomosis

the clinical impact of antegrade pulmonary blood flow on the bidirectional cavopulmonary shunt in infants

2004 ◽  
Vol 14 (S3) ◽  
pp. 44-47 ◽  
Author(s):  
lucia migliazza ◽  
francesco seddio ◽  
francesco paolo annecchino ◽  
giancarlo crupi
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Ventricular Dysfunction ◽  
Fontan Procedure ◽  
Volume Overload ◽  
Clinical Impact ◽  
Cavopulmonary Anastomosis ◽  
Alternative Sources ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Cavopulmonary Shunt

the bidirectional cavopulmonary anastomosis is commonly used in the palliation of patients with a functionally univentricular physiology. the management of alternative sources of flow of blood to the lungs, as well as the magnitude of acceptable accessory blood flow at the time of surgery, nonetheless, remains controversial. these issues are particularly significant when a cavopulmonary anastomosis is performed in infants who may become candidates for a fontan procedure. indeed, a long-standing volume overload, which is invariably associated with the maintenance of accessory sources of pulmonary blood flow, may result in systemic ventricular dysfunction. these observations prompted us to review the influence of antegrade pulmonary blood flow in the management of infants undergoing a cavopulmonary anastomosis.

Conversion of Right Atrioventricular to Total Cavopulmonary Anastomosis in the Management of Post-Fontan Arrhythmia: Report of a Case

Surgery Today ◽  
1999 ◽  
Vol 29 (3) ◽  
pp. 284-287
Author(s):  
Naoki Yoshimura ◽  
Masahiro Yamaguchi ◽  
Hidetaka Ohashi ◽  
Yoshihiro Oshima ◽  
Yoshiya Toyoda ◽  
...  
Keyword(s):  
Cavopulmonary Anastomosis ◽  
Total Cavopulmonary Anastomosis

The role of angiogenesis in the development of pulmonary arteriovenous malformations in children after cavopulmonary anastomosis

1997 ◽  
Vol 7 (4) ◽  
pp. 370-374 ◽  
Author(s):  
Blair Marshall ◽  
Brian W. Duncan ◽  
Richard A. Jonas
Keyword(s):  
Arteriovenous Malformations ◽  
Fontan Procedure ◽  
Pulmonary Arteriovenous Malformations ◽  
Arterial Circulation ◽  
Clinical Observations ◽  
Bidirectional Glenn Shunt ◽  
Cavopulmonary Anastomosis ◽  
Pulmonary Arterial ◽  
End Stage

AbstractPulmonary arteriovenous malformations are a frequent cause of progressive cyanosis after construction of a cavopulmonary anastomosis. Their formation complicates the management of children with single ventricle physiology after a bidirectional Glenn shunt or the Kawashima procedure. The key role of the liver in this phenomenon is suggested by the observation that providing modifications of the Fontan procedure which permit hepatic venous effluent to reach the pulmonary arterial circulation limit further development of the malformations. In addition, it is known that patients with end-stage hepatic failure develop pulmonary arteriovenous malformations that diminish after liver transplantation. We have begun purification of a factor derived from hepatocyte-conditioned media that is inhibitory for the proliferation of cultured endothelial cells. This substance is heat sensitive, and binds avidly to a copper-containing chromatography column. These clinical observations, and this preliminary experimental work, support the concept that hepatic-derived angiogenic factors may play a role in the development of pulmonary arteriovenous malformations after construction of cavopulmonary anastomoses.

scholarly journals Conversion of modified fontan procedure to lateral atrial tunnel cavopulmonary anastomosis

1996 ◽  
Vol 111 (6) ◽  
pp. 1169-1176 ◽  
Author(s):  
Jacqueline Kreutzer ◽  
John F. Keane ◽  
James E. Lock ◽  
Edward P. Walsh ◽  
Richard A. Jonas ◽  
...  
Keyword(s):  
Fontan Procedure ◽  
Cavopulmonary Anastomosis

Risk Factors For Unfavorable Outcomes After Bidirectional Cavopulmonary Anastomosis

2017 ◽  
Vol 8 (5) ◽  
pp. 575-583 ◽  
Author(s):  
Nataliya R. Nichay ◽  
Yuriy N. Gorbatykh ◽  
Igor A. Kornilov ◽  
Ilya A. Soynov ◽  
Yuriy Y. Kulyabin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Fontan Procedure ◽  
Unfavorable Outcome ◽  
Atrioventricular Valve Regurgitation ◽  
Cavopulmonary Anastomosis ◽  
Mean Pressure ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Anomalous Pulmonary Venous Connection

Background: Bidirectional cavopulmonary anastomosis (BCPA) is an important preliminary step toward the Fontan procedure; thus, understanding of risk factors for morbidity and mortality after BCPA may ultimately promote improved rates of success with Fontan completion and general survival. This study evaluated survival and predictors of unfavorable outcomes in patients after BCPA. Methods: Clinical data of 157 patients who underwent BCPA from 2003 to 2015 at a single center were retrospectively analyzed. Results: Three-year and nine-year survival after BCPA were 87.1% ± 2.8% and 85.8% ± 2.9%, respectively. Freedom from unfavorable outcomes (mortality, BCPA takedown, nonsuitability for Fontan procedure) was 83.8% ± 3.1% at three years and 73.5% ± 4.8% at nine years. Multivariate proportional hazards regression analysis revealed that total anomalous pulmonary venous connection (TAPVC; hazard ratio [HR]: 3.74, 95% confidence interval [CI]: 1.35-10.36; P = .01) and increased mean pressure in BCPA circuit (HR: 1.17, 95% CI: 1.02-1.34; P = .03) were independent risk factors for unfavorable outcomes. Postoperative mean pressure in BCPA circuit in patients with poor outcomes was median 16 mm Hg (interquartile range [IQR]: 14-18 mm Hg) versus median 14 mm Hg (IQR: 12-15.5 mm Hg) in patients with favorable outcomes ( P < .01). Preoperative (HR: 1.87, 95% CI: 1.20-2.91; P < .01) and postoperative atrioventricular valve regurgitation (AVVR; HR: 2.22, 95% CI: 1.24-3.94; P < .01) were also associated with unfavorable outcome in univariate Cox regression. Conclusions: Elevated mean pressure in the BCPA circuit is the main predictor of unfavorable outcome; therefore, thorough preoperative examination and careful patient selection are critical points for successful intermediate-stage and later Fontan completion. Total anomalous pulmonary venous connection and insufficient correction of AVVR worsen the prognosis in this patient group.

Total Cavopulmonary Anastomosis in Patients Less Than Three Years of Age

1995 ◽  
Vol 60 (6) ◽  
pp. S563-S567
Author(s):  
Renate Kaulitz ◽  
Gerhard Ziemer ◽  
Ingrid Luhmer ◽  
Thomas Paul ◽  
Hans C. Kallfelz
Keyword(s):  
Cavopulmonary Anastomosis ◽  
Total Cavopulmonary Anastomosis

scholarly journals Cardiac performance and quality of life in patients who have undergone the Fontan procedure with and without prior superior cavopulmonary connection

2012 ◽  
Vol 23 (3) ◽  
pp. 335-343 ◽  
Author(s):  
Andrew M. Atz ◽  
Thomas G. Travison ◽  
Brian W. McCrindle ◽  
Lynn Mahony ◽  
Andrew C. Glatz ◽  
...  
Keyword(s):  
Fontan Procedure ◽  
Cross Sectional Study ◽  
Univentricular Heart ◽  
P Value ◽  
Cross Sectional ◽  
Ventricular Performance ◽  
Cavopulmonary Anastomosis ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Fontan Surgery ◽  
Cavopulmonary Connection

AbstractBackgroundA superior cavopulmonary connection is commonly performed before the Fontan procedure in patients with a functionally univentricular heart. Data are limited regarding associations between a prior superior cavopulmonary connection and functional and ventricular performance late after the Fontan procedure.MethodsWe compared characteristics of those with and without prior superior cavopulmonary connection among 546 subjects enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study. We further compared different superior cavopulmonary connection techniques: bidirectional cavopulmonary anastomosis (n equals 229), bilateral bidirectional cavopulmonary anastomosis (n equals 39), and hemi-Fontan (n equals 114).ResultsA prior superior cavopulmonary connection was performed in 408 subjects (75%); the proportion differed by year of Fontan surgery and centre (p-value less than 0.0001 for each). The average age at Fontan was similar, 3.5 years in those with superior cavopulmonary connection versus 3.2 years in those without (p-value equals 0.4). The type of superior cavopulmonary connection varied by site (p-value less than 0.001) and was related to the type of Fontan procedure. Exercise performance, echocardiographic variables, and predominant rhythm did not differ by superior cavopulmonary connection status or among superior cavopulmonary connection types. Using a test of interaction, findings did not vary according to an underlying diagnosis of hypoplastic left heart syndrome.ConclusionsAfter controlling for subject and era factors, most long-term outcomes in subjects with a prior superior cavopulmonary connection did not differ substantially from those without this procedure. The type of superior cavopulmonary connection varied significantly by centre, but late outcomes were similar.

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