The efficacy of pacemaker implantation for extracardiac total cavopulmonary connection in a pediatric patient with bradycardia-tachycardia syndrome

2021 ◽  
Author(s):  
Shuhei Fujita ◽  
Eriko Kabata ◽  
Keigo Nishida ◽  
Kazuyuki Ueno ◽  
Takeshi Futatani ◽  
...  
Keyword(s):  
Pediatric Patient ◽  
Pacemaker Implantation ◽  
Total Cavopulmonary Connection ◽  
Cavopulmonary Connection

Fontan completions over 10 years after Glenn procedures

2013 ◽  
Vol 24 (2) ◽  
pp. 290-296 ◽  
Author(s):  
Koichi Sughimoto ◽  
Kozo Matsuo ◽  
Koichiro Niwa ◽  
Yasutaka Kawasoe ◽  
Shigeru Tateno ◽  
...  
Keyword(s):  
Fontan Procedure ◽  
Pacemaker Implantation ◽  
Early Period ◽  
Maze Procedure ◽  
Total Cavopulmonary Connection ◽  
Atrioventricular Valve ◽  
Atrioventricular Valve Regurgitation ◽  
Lateral Tunnel ◽  
Cavopulmonary Connection ◽  
Glenn Procedure

AbstractObjective: 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.

Is it necessary to fenestrate an extracardiac total cavopulmonary connection?

2005 ◽  
Vol 53 (S 01) ◽  
Author(s):  
C Schreiber ◽  
M Kostolny ◽  
J Hörer ◽  
J Cleuziou ◽  
K Holper ◽  
...  
Keyword(s):  
Total Cavopulmonary Connection ◽  
Cavopulmonary Connection

Pulmonary blood flow distribution after the total cavopulmonary connection for complex cardiac anomalies

1999 ◽  
Vol 14 (3) ◽  
pp. 154-160 ◽  
Author(s):  
Masao Tayama ◽  
Nobuaki Hirata ◽  
Tohru Matsushita ◽  
Tetsuya Sano ◽  
Norihide Fukushima ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Flow Distribution ◽  
Total Cavopulmonary Connection ◽  
Blood Flow Distribution ◽  
Cardiac Anomalies ◽  
Cavopulmonary Connection

scholarly journals Total cavopulmonary connection

1989 ◽  
Vol 97 (4) ◽  
pp. 636 ◽  
Author(s):  
Marc R. de Leval ◽  
Philip Kilner ◽  
Marc Gewillig ◽  
Catherine Bull
Keyword(s):  
Total Cavopulmonary Connection ◽  
Cavopulmonary Connection

Early postoperative extubation of unstable patients following total cavopulmonary connection: impact on circulation and outcome

2016 ◽  
Vol 27 (5) ◽  
pp. 860-869 ◽  
Author(s):  
Stanimir Georgiev ◽  
Gunter Balling ◽  
Bettina Ruf ◽  
Kilian Ackermann ◽  
Jelena P. von Ohain ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Fontan Operation ◽  
Management Tool ◽  
Total Cavopulmonary Connection ◽  
Early Extubation ◽  
Respective Group ◽  
Group 2 ◽  
Cavopulmonary Connection ◽  
Group 1 ◽  
Sustained Increase

AbstractObjectivesWe aimed to investigate whether early postoperative extubation following the Fontan operation is universally feasible and can be used as a management tool in unstable patients.MethodsAll patients undergoing the Fontan operation in our centre between 2004 and 2013 (n=253) were analysed. Until 2008, patients were extubated according to standard criteria and comprised group 1. Group 2 included all patients presenting after 2009, when early extubation was always aimed regardless of the haemodynamic status. Patients who exceeded the 75th percentiles for volume requirements and inotrope scores for the respective group were defined as unstable. Comparisons of outcomes between groups and subgroups and analysis of the changes in haemodynamic and treatment parameters with extubation in unstable patients after 2009 were performed.ResultsCompared with group 1, patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.50), and needed less volume (p=0.01). In group 2, the unstable patients were not ventilated for longer durations (p=0.19), but had higher re-intubation rates (p=0.03) than the stable patients. Compared with the unstable patients from group 1, the unstable patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.66), and needed less volume (p=0.006). There was a significant acute and sustained increase in mean arterial pressure with extubation and a parallel reduction in volume requirements and inotrope scores in the unstable patients from group 2.ConclusionsTimely extubation is universally applicable following the Fontan operation. Early postoperative extubation can be valuable for improving Fontan haemodynamics.

The Effect of Incorporating Vessel Compliance in a Computational Model of Blood Flow in a Total Cavopulmonary Connection (TCPC) with Caval Centerline Offset

2004 ◽  
Vol 126 (6) ◽  
pp. 709-713 ◽  
Author(s):  
J. C. Masters ◽  
M. Ketner ◽  
M. S. Bleiweis ◽  
M. Mill ◽  
A. Yoganathan ◽  
...  
Keyword(s):  
Blood Flow ◽  
Power Loss ◽  
Fluid Dynamic ◽  
Reducing Power ◽  
Pressure Head ◽  
Congenital Defects ◽  
Total Cavopulmonary Connection ◽  
Flow Mixing ◽  
The Right ◽  
Cavopulmonary Connection

Background—The total cavopulmonary connection (TCPC), a palliative correction for congenital defects of the right heart, is based on the corrective technique developed by Fontan and Baudet. Research into the TCPC has primarily focused on reducing power loss through the connection as a means to improve patient longevity and quality of life. The goal of our study is to investigate the efficacy of including a caval offset on the hemodynamics and, ultimately, power loss of a connection. As well, we will quantify the effect of vessel wall compliance on these factors and, in addition, the distribution of hepatic blood to the lungs. Methods—We employed a computational fluid dynamic model of blood flow in the TCPC that includes both the non-Newtonian shear thinning characteristics of blood and the nonlinear compliance of vessel tissue. Results—Power loss in the rigid-walled simulations decayed exponentially as caval offset increased. The compliant-walled results, however, showed that after an initial substantial decrease in power loss for offsets up to half the caval diameter, power loss increased slightly again. We also found only minimal mixing in both simulations of all offset models. Conclusions—The increase in power loss beyond an offset of half the caval diameter was due to an increase in the kinetic contribution. Reduced caval flow mixing, on the other hand, was due to the formation of a pressure head in the offset region which acts as a barrier to flow.

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