scholarly journals The Effects of Modification to Lateral Tunnel Fontan Procedure for Prophylactic Arrhythmia Surgery

2017 ◽  
Vol 104 (1) ◽  
pp. 197-204 ◽  
Author(s):  
Hong-Gook Lim ◽  
Jeong Ryul Lee ◽  
Yong Jin Kim
Keyword(s):  
Fontan Procedure ◽  
Lateral Tunnel ◽  
Arrhythmia Surgery

Optimal Initial Palliation for Patients With Functionally Univentricular Hearts

2012 ◽  
Vol 3 (2) ◽  
pp. 165-170 ◽  
Author(s):  
Carl Lewis Backer ◽  
Hyde M. Russell ◽  
Barbara J. Deal
Keyword(s):  
Surgical Intervention ◽  
Fontan Procedure ◽  
Univentricular Heart ◽  
Bidirectional Glenn ◽  
Lateral Tunnel ◽  
Potential Problems ◽  
Fontan Conversion ◽  
Extracardiac Fontan ◽  
Pulmonary Vein Obstruction ◽  
Arrhythmia Surgery

This review will outline the optimal, initial palliation for children who are born with a functionally univentricular heart. Optimizing the initial palliation is of critical importance in this patient population to prevent potential problems such as systemic outflow and pulmonary vein obstruction that may complicate further surgical intervention. The palliative techniques that are discussed include pulmonary artery banding, modified Blalock-Taussig shunt, Damus-Kaye-Stansel procedure, modified Norwood, hybrid, and early bidirectional Glenn. Our recommendations for optimal palliation for children with a univentricular heart are based on our experience with nearly 200 patients who had either a lateral tunnel or extracardiac Fontan procedure and 130 patients who had Fontan conversion with arrhythmia surgery.

12th Annual C. Walton Lillehei Memorial Lecture in Cardiovascular Surgery: Fontan conversion – the Chicago experience

2011 ◽  
Vol 21 (S2) ◽  
pp. 169-176 ◽  
Author(s):  
Carl L. Backer
Keyword(s):  
Cardiac Transplantation ◽  
Operative Mortality ◽  
Cardiovascular Surgery ◽  
Fontan Procedure ◽  
Memorial Lecture ◽  
Univentricular Heart ◽  
Fontan Conversion ◽  
Double Inlet Left Ventricle ◽  
Arrhythmia Surgery

AbstractBetween 1994 and 2011, we performed 133 Fontan conversions with arrhythmia surgery. Most patients had tricuspid atresia or double-inlet left ventricle with prior atriopulmonary connection. Operative mortality was 1.5%, and mean length of stay was 14 days. A total of eight patients (6%) have had late cardiac transplantation. Freedom from arrhythmia recurrence is 85% at 10 years. For properly selected patients with a functionally univentricular heart who have had an atriopulmonary Fontan procedure, Fontan conversion with arrhythmia surgery significantly improves quality of life.

Investigation of Vessel Growth and its Impact on Hemodynamics in Patients With Lateral Tunnel Total Cavopulmonary Connection

2012 ◽  
Author(s):  
Maria Restrepo ◽  
Lucia Mirabella ◽  
Elaine Tang ◽  
Chris Haggerty ◽  
Mark A. Fogel ◽  
...  
Keyword(s):  
Heart Defects ◽  
Fontan Procedure ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Total Cavopulmonary Connection ◽  
Lateral Tunnel ◽  
Vessel Growth ◽  
Original Size ◽  
The Right ◽  
Cavopulmonary Connection

Single ventricle heart defects affect 2 per 1000 live births in the US and are lethal if left untreated. The Fontan procedure used to treat these defects consists of a series of palliative surgeries to create the total cavopulmonary connection (TCPC), which bypasses the right heart. In the last stage of this procedure, the inferior vena cava (IVC) is connected to the pulmonary arteries (PA) using one of the two approaches: the extra-cardiac (EC), where a synthetic graft is used as the conduit; and the lateral tunnel (LT) where part of the atrial wall is used along with a synthetic patch to create the conduit. The LT conduit is thought to grow in size in the long term because it is formed partially with biological tissue, as opposed to the EC conduit that retains its original size because it contains only synthetic material. The growth of the LT has not been yet quantified, especially in respect to the growth of other vessels forming the TCPC. Furthermore, the effect of this growth on the hemodynamics has not been elucidated. The objective of this study is to quantify the TCPC vessels growth in LT patients from serial magnetic resonance (MR) images, and to understand its effect on the connection hemodynamics using computational fluid dynamics (CFD).

Computational Model for the Study of Fontan Circulation

2018 ◽  
pp. 587-606
Author(s):  
Alejandro Talaminos-Barroso ◽  
Laura María Roa-Romero ◽  
Javier Reina-Tosina
Keyword(s):  
Computational Model ◽  
Cardiovascular System ◽  
Fontan Procedure ◽  
Fontan Operation ◽  
Univentricular Heart ◽  
Physiological Basis ◽  
Hemodynamic Variables ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Key Factor

In this chapter, the design and development of a computational model of the cardiovascular system is presented for patients who have undergone the Fontan operation. The model has been built from a physiological basis, considering some of the mechanisms associated to the cardiovascular system of patients with univentricular heart disease. Thus, the model allows the prediction of some hemodynamic variables considering different physiopathological conditions. The original conditions of the model are changed in the Fontan procedure and these new dynamics force the hemodynamic behaviours of the different considered variables. The model has been proved considering the classic Fontan procedure and the techniques from the lateral tunnel and the extracardiac conduit. The results compiled knowledge of several cardiovascular surgeons with many years of experience in such interventions, and have been validated by using other authors' data. In this sense, the participation of a multidisciplinary team has been considered as a key factor for the development of this work.

The Lateral Tunnel Fontan Procedure for Hypoplastic Left Heart Syndrome: Results of 100 Consecutive Patients

2007 ◽  
Vol 28 (6) ◽  
pp. 426-432 ◽  
Author(s):  
J. C. Hirsch ◽  
R. G. Ohye ◽  
E. J. Devaney ◽  
C. S. Goldberg ◽  
E. L. Bove
Keyword(s):  
Hypoplastic Left Heart Syndrome ◽  
Fontan Procedure ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Lateral Tunnel ◽  
Left Heart Syndrome

scholarly journals 2453

2017 ◽  
Vol 1 (S1) ◽  
pp. 29-29
Author(s):  
Angela Weingarten ◽  
Daniel E. Clark ◽  
Ryan D. Byrne ◽  
Patricia Y. Chu ◽  
Frank A. Fish ◽  
...  
Keyword(s):  
Fontan Procedure ◽  
Adult Survivors ◽  
Atrial Arrhythmia ◽  
Morbidity And Mortality ◽  
Right Atrial ◽  
Significant Morbidity ◽  
Heart Transplants ◽  
Systemic Right Ventricle ◽  
Lateral Tunnel ◽  
Significant Difference

OBJECTIVES/SPECIFIC AIMS: The morbidity and mortality in adults with single ventricular hearts who have undergone Fontan palliation is poorly defined. These patients have a high burden of arrhythmia, heart failure, and re-operation. We hypothesized that age and type of Fontan predict occurrence of arrhythmia. METHODS/STUDY POPULATION: In total, 205 patients aged 18 years who had undergone a Fontan procedure were identified. Those with incomplete data were excluded. Demographic, anatomic, pharmacologic, imaging, hemodynamic, and electrophysiologic data were collected. The χ2 and Mann-Whitney U tests were used to test significance defined as p<0.05. RESULTS/ANTICIPATED RESULTS: Of the 205 patients identified, 59 had been lost to follow-up. Of the 146 patients (77, 53% female) actively followed 18 (12%) had died at a median (IQR) age of 27 (21–34.3); in patients alive as of 10/2016 the median age was 26 years (22–34). Fontan types were lateral tunnel (LT) (n=79, 54.1%), extracardiac (EC) (n=32, 22%), right atrial to pulmonary artery (RV-PA) (n=28, 19%), and Fontan with Bjork modification (n=4, 2.7%). Systemic left ventricle (n=96, 66%) was more common than systemic right ventricle (n=43, 30%). Of the 146 patients, 101 (69%) had significant morbidity or mortality: 86 (59%) were diagnosed with arrhythmia, 18 (12%) died, and 11 (8%) underwent heart transplants. Frequent procedures included: Fontan revisions/cryoablation in 28 (19%), electrophysiology studies with ablation in 73 (50%), and pacemakers in 53 (36%). Of the arrhythmia diagnoses, 57 (64%) were atrial tachyarrhythmias. RV-PA Fontan procedures were associated with significantly more atrial arrhythmia than all other Fontan types (70% vs. 30%; p<0.01). There was no statistical difference in occurrence of atrial arrhythmia in adults with LT Versus EC Fontans (p=0.3). While patients who had undergone RV-PA and Bjork Fontans were older with median age 34 years, there was no significant difference in age between LT and EC (median 24.0 and 24.5). DISCUSSION/SIGNIFICANCE OF IMPACT: Adult survivors of the Fontan procedure suffer from significant morbidity and mortality. The single most prevalent morbidity is atrial arrhythmia. We conclude that RV-PA Fontans, now obsolete, have the highest prevalence of arrhythmia and that there is no difference in arrhythmia burden between LT and EC Fontans. Given the high prevalence of morbidity and mortality in this population, it is imperative that they be followed by cardiologists with expertise in congenital heart disease.

scholarly journals A 45-year experience with the Fontan procedure: tachyarrhythmia, an important sign for adverse outcome

2019 ◽  
Vol 29 (3) ◽  
pp. 461-468 ◽  
Author(s):  
Friso M Rijnberg ◽  
Nico A Blom ◽  
Vladimir Sojak ◽  
Eline F Bruggemans ◽  
Irene M Kuipers ◽  
...  
Keyword(s):  
Adverse Outcome ◽  
Sinus Node ◽  
Fontan Procedure ◽  
Study Cohort ◽  
Protein Losing Enteropathy ◽  
Long Term Outcome ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Fontan Failure ◽  
Important Sign

Abstract OBJECTIVES This study aims to evaluate our 45-year experience with the Fontan procedure and to identify risk factors for late mortality and morbidity. METHODS Demographic, preoperative, perioperative and postoperative characteristics were retrospectively collected for all patients who underwent a Fontan procedure in a single centre between 1972 and 2016. RESULTS The study included 277 Fontan procedures (44 atriopulmonary connections, 28 Fontan-Björk, 42 lateral tunnels and 163 extracardiac conduits). Early failure occurred in 17 patients (6.1%). Median follow-up of the study cohort was 11.9 years (Q1–Q3 7.6–17.5). Longest survival estimates were 31% [95% confidence intervals (CI) 18–44%] at 35 years for atriopulmonary connection/Björk, 87% (95% CI 63–96%) at 20 years for lateral tunnel and 99% (95% CI 96–100%) at 15 years for extracardiac conduit. Estimated freedom from Fontan failure (death, heart transplant, take-down, protein-losing enteropathy, New York Heart Association III–IV) at 15 years was 65% (95% CI 52–76%) for atriopulmonary connection/Björk, 90% (95% CI 73–97%) for lateral tunnel and 90% (95% CI 82–94%) for extracardiac conduit. The development of tachyarrhythmia was an important predictor of Fontan failure [hazard ratio (HR) 2.6, 95% CI 1.2–5.8; P = 0.017], thromboembolic/neurological events (HR 3.6, 95% CI 1.4–9.4; P = 0.008) and pacemaker for sinus node dysfunction (HR 3.7, 95% CI 1.4–9.6; P = 0.008). Prolonged pleural effusion (>21 days) increased the risk of experiencing protein-losing enteropathy (HR 4.7, 95% CI 2.0–11.1; P < 0.001). CONCLUSIONS With modern techniques, survival and freedom from Fontan failure are good. However, Fontan patients remain subject to general attrition. Tachyarrhythmia is an important sign for an adverse outcome. Prevention and early treatment of tachyarrhythmia may, therefore, be paramount in improving the long-term outcome.

Sign in / Sign up

Export Citation Format

Share Document