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.

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).

scholarly journals Transesophageal Echocardiographic Evaluation of Crisscross Heart with Atrioventricular Valve Regurgitation for Fontan Procedure

2016 ◽  
Vol 4 (1) ◽  
pp. 27-29
Author(s):  
Anita Saxena ◽  
Sachin Talwar ◽  
Vandana Bhardwaj ◽  
Neeti Makhija
Keyword(s):  
Fontan Procedure ◽  
Venous Blood ◽  
Atrioventricular Valve ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
Atrioventricular Valve Regurgitation ◽  
Congenital Cardiac Malformation ◽  
Echocardiographic Evaluation ◽  
Fontan Surgery ◽  
Glenn Procedure

ABSTRACT Crisscross heart (CCH) is a rare congenital cardiac malformation characterized by crossing of systemic and pulmonary venous blood streams at atrioventricular (A-V) level due to an apparent twisting of the heart about its long axis. In the literature, perioperative evaluation of CCH by transesophageal echocardiography (TEE) has not been described. Here we report a rare case of CCH, post Glenn procedure with A-V valve regurgitation, evaluated by TEE for valve repair/replacement followed by completion of Fontan surgery. How to cite this article Makhija N, Bhardwaj V, Saxena A, Talwar S. Transesophageal Echocardiographic Evaluation of Crisscross Heart with Atrioventricular Valve Regurgitation for Fontan Procedure. J Perioper Echocardiogr 2016;4(1):27-29.

scholarly journals Midterm Prognosis and Effectiveness of Fontan Procedure with Total Cavopulmonary Connection Performed in Adults

2018 ◽  
Vol 34 (3) ◽  
pp. 143-152
Author(s):  
Taku Ishii ◽  
Tadahiro Yoshikawa ◽  
Satoshi Yazaki ◽  
Takumi Kobayashi ◽  
Kanako Kishiki ◽  
...  
Keyword(s):  
Fontan Procedure ◽  
Total Cavopulmonary Connection ◽  
Cavopulmonary Connection

scholarly journals Ultra‐high density mapping of intra‐atrial reentrant tachycardia in a patient after a lateral tunnel total cavopulmonary connection

2019 ◽  
Vol 35 (6) ◽  
pp. 848-850
Author(s):  
Hitoshi Mori ◽  
Naokata Sumitomo ◽  
Shota Muraji ◽  
Noriyuki Iwashita ◽  
Toshiki Kobayashi ◽  
...  
Keyword(s):  
High Density ◽  
Total Cavopulmonary Connection ◽  
Reentrant Tachycardia ◽  
Density Mapping ◽  
Lateral Tunnel ◽  
Cavopulmonary Connection

scholarly journals Atrioventricular valve closure in Fontan palliation

2019 ◽  
Vol 57 (5) ◽  
pp. 945-950 ◽  
Author(s):  
Gregory King ◽  
David S Winlaw ◽  
Nelson Alphonso ◽  
David Andrews ◽  
Kirsten Finucance ◽  
...  
Keyword(s):  
Single Ventricle ◽  
Fontan Procedure ◽  
Population Based ◽  
Valve Closure ◽  
Atrioventricular Valve ◽  
Atrioventricular Valve Regurgitation ◽  
Patch Technique ◽  
Pacemaker Insertion ◽  
Population Based Registry

Abstract OBJECTIVES Atrioventricular valve regurgitation is known to adversely impact outcomes of single-ventricle palliation, and valve repair rarely provides long-lasting results. Closure of a atrioventricular valve can sometimes be performed, but the long-term outcomes of this manoeuvre are unknown. METHODS This retrospective study was conducted using patient data extracted from an existing bi-national, population-based registry of survivors of the Fontan procedure. RESULTS Between January 1975 and June 2018, 1574 patients survived to hospital discharge with an intact Fontan circulation. Of these patients, 128 with a common atrioventricular valve were excluded. Thirty-eight patients underwent closure of an atrioventricular valve, and complete follow-up data were available for 36 patients. Twenty-nine patients underwent closure of the tricuspid valve and 7 patients underwent closure of the mitral valve. Seventeen patients underwent valve closure prior to Fontan, 13 patients underwent valve closure concomitant with Fontan and 6 patients underwent valve closure post-Fontan. Valve closure was performed using a patch technique in 29 cases and with direct suture in 7 cases. At the most recent echocardiography, 33 patients had no regurgitation, 2 patients had recurrent mild regurgitation and 1 patient had no echocardiographic follow-up. Six patients required reintervention post-valve closure and 7 patients required permanent pacemaker insertion post-valve closure. Freedom from reintervention at 1, 5 and 18 years post-valve closure was 86% [95% confidence interval (CI) 76–98%], 83% (95% CI 72–96%) and 83% (95% CI 72–96%), respectively. CONCLUSION Atrioventricular valve closure is an effective surgical technique in selected patients with a single ventricle providing long-lasting competency in the majority of cases.

scholarly journals Staged total cavopulmonary connection: serial comparison of intra-atrial lateral tunnel and extracardiac conduit taking account of current surgical adaptations

2019 ◽  
Vol 29 (3) ◽  
pp. 453-460 ◽  
Author(s):  
Eva van den Bosch ◽  
Sjoerd S M Bossers ◽  
Ad J J C Bogers ◽  
Daniëlle Robbers-Visser ◽  
Arie P J van Dijk ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Total Cavopulmonary Connection ◽  
Overall Survival Rate ◽  
Free Survival ◽  
Patient Demographics ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Cavopulmonary Connection

AbstractOBJECTIVESOur goals were to compare the outcome of the intra-atrial lateral tunnel (ILT) and the extracardiac conduit (ECC) techniques for staged total cavopulmonary connection (TCPC) and to compare the current modifications of the TCPC technique, i.e. the prosthetic ILT technique with the current ECC technique with a ≥18-mm conduit.METHODSWe included patients who had undergone a staged TCPC between 1988 and 2008. Records were reviewed for patient demographics, operative details and events during follow-up (death, surgical and catheter-based reinterventions and arrhythmias).RESULTSOf the 208 patients included, 103 had the ILT (51 baffle, 52 prosthetic) technique and 105 had the ECC technique. Median follow-up duration was 13.2 years (interquartile range 9.5–16.3). At 15 years after the TCPC, the overall survival rate was comparable (81% ILT vs 89% ECC; P = 0.12). Freedom from late surgical and catheter-based reintervention was higher for patients who had ILT than for those who had ECC (63% vs 44%; P = 0.016). However, freedom from late arrhythmia was lower for patients who had ILT than for those who had ECC (71% vs 85%, P = 0.034). In a subgroup of patients who had the current TCPC technique, when we compared the use of a prosthetic ILT with ≥18-mm ECC, we found no differences in freedom from late arrhythmias (82% vs 86%, P = 0.64) or in freedom from late reinterventions (70% vs 52%, P = 0.14).CONCLUSIONSA comparison between the updated prosthetic ILT and current ≥18-mm ECC techniques revealed no differences in late arrhythmia-free survival or late reintervention-free survival. Overall, outcomes after the staged TCPC were relatively good and reinterventions occurred more frequently in the ECC group, whereas late arrhythmias were more common in the ILT group.

scholarly journals Exercise capacity in children after total cavopulmonary connection: Lateral tunnel versus extracardiac conduit technique

2014 ◽  
Vol 148 (4) ◽  
pp. 1490-1497 ◽  
Author(s):  
Sjoerd S.M. Bossers ◽  
Willem A. Helbing ◽  
Nienke Duppen ◽  
Irene M. Kuipers ◽  
Michiel Schokking ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Total Cavopulmonary Connection ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Cavopulmonary Connection
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