scholarly journals Risk factors for the development of arrhythmias after the fontan surgery

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Fernandez Domenech ◽  
WA Ortiz-Solis ◽  
A Cueva-Parra ◽  
JR Gomez-Flores ◽  
S Nava-Townsend
Keyword(s):  
Protective Factor ◽  
Pulmonary Atresia ◽  
Double Outlet Right Ventricle ◽  
Complex Congenital Heart Disease ◽  
Total Cavopulmonary Connection ◽  
Chi Square ◽  
Palliative Procedure ◽  
Qrs Duration ◽  
Fontan Surgery ◽  
Cavopulmonary Connection

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Fontan surgery or total cavopulmonary connection is a palliative procedure for complex congenital heart disease with univentricular physiology, without the possibility of biventricular surgical correction. This surgery has a high mortality rate (70%), with heart failure and arrhythmias being the main causes of death. Objective Identify the pre, intra and post-surgical factors that may predispose to arrhythmias in patients undergoing to Fontan surgery. Methods We conducted a retrospective review of the patients who underwent a total cavopulmonary connection from January 2003 to December 2018. We performed an analysis employing the Chi-square test to determine which variables were associated with the development of arrhythmias. Results During the mentioned period, 115 patients underwent to Fontan surgery, of which 51.3% were women, the average age at the time of surgery was 8 years. The most frequent diagnosis was tricuspid atresia in 44 patients (38.2%), followed by pulmonary atresia in 18 patients (15.7%) and double outlet right ventricle in 14 patients (12.2%). Regarding the type of the procedures performed, 93.9% (n = 108) were total extracardiac cavopulmonary connection and 6.1% (n = 7) were intracardiac. Also, 8.6% (n = 10) were taken to fenestration, the mean size of the fenestration was 7 mm (7 ± 3 mm) After Fontan surgery, there was a high incidence of arrhythmias which was 38% (n = 44). 22 patients (50%) presented them in the late postoperative period, being this, the most frequent time for the appearance of arrhythmias. We found that the intracardiac surgery presented an OR of 4.423 (95% CI 0.819 - 23.879, p> 0.05), being not statistically significant. Instead, the bidirectional cavopulmonary shunt previous to the Fontan surgery presented an OR of 0.255 (95% CI 0.081 - 0.806, p <0.05) and on the other hand the QRS duration > 120 ms was significantly associated with the appearance of arrythmias with an OR 2.99 (95% CI 1.2-4.2, p <0.05). Conclusions In patients undergoing to Fontan surgery, the previous bidirectional cavopulmonary bypass is a protective factor for the development of arrhythmias. And an QRS duration > 120 ms is a parameter that predicts the apparence of arrhythmias. Abstract Figure. QRS INTERVAL POST FONTAN SURGERY

scholarly journals Catheter ablation of macroreentrant atrial tachycardias following transconduit puncture access in a patient after total cavopulmonary connection with an extracardiac conduit

2021 ◽  
Vol 27 (3) ◽  
pp. 113-122
Author(s):  
Vassil Traykov ◽  
Tchavdar Shalganov ◽  
Lyubomir Dimitrov ◽  
Anna Kaneva ◽  
Stojan Lazarov ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Pulmonary Veins ◽  
Balloon Dilation ◽  
Right Atrial ◽  
Ventricular Rate ◽  
Complex Congenital Heart Disease ◽  
Total Cavopulmonary Connection ◽  
Surgical Interventions ◽  
Extracardiac Conduit ◽  
Cavopulmonary Connection

We present the case of a 23-year-old male diagnosed with a complex congenital heart disease (with single ventricle physiology) which necessitated many surgical interventions including total cavopulmonary connection. The patient presents with recurrent (almost daily) highly symptomatic atrial tachycardia with rapid ventricular rate and poor haemodynamic tolerance. Due to failure of antiarrhythmic drug therapy the patient was referred for catheter ablation. Atrial access was provided following transconduit puncture with a standard transseptal set. Crossing to the atrium with the transseptal introducer was not successful due to resistance from the conduit and the atrial wall. Therefore, balloon dilation of the puncture using a cutting balloon was carried out which resulted in easy crossing to the atrium with a steerable transseptal introducer. Several atrial tachyarrhythmias were induced two of which allowed mapping demonstrating a macroreentrant tachycardia dependent on the cavoannular isthmus as well as a complex fi gure-of-eight circuit involving right pulmonary veins and the right atrial appendage. Linear lesions transecting the critical isthmuses of the two circuits were delivered which rendered the patient noninducible. During a 9-month follow-up period the patient remained arrhythmia free.

scholarly journals A case of COVID-19 in a patient with a univentricular heart post total cavopulmonary connection (Fontan) surgery

2020 ◽  
Vol 30 (9) ◽  
pp. 1350-1352
Author(s):  
Niall Linnane ◽  
Des W. Cox ◽  
Adam James
Keyword(s):  
Healthcare Systems ◽  
Health Conditions ◽  
Univentricular Heart ◽  
Total Cavopulmonary Connection ◽  
Global Pandemic ◽  
The World ◽  
Fontan Surgery ◽  
Cavopulmonary Connection

AbstractCoronavirus disease 2019 (COVID-19) has caused a global pandemic which has affected patients and healthcare systems around the world. Patients with underlying health conditions seem to be more severely affected. There are limited reports of patients with univentricular circulations and COVID 19; thus, we report a case of COVID-19 in a patient with a univentricular circulation.

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

Outcomes of management of major aortopulmonary collaterals for pulmonary atresia and ventricular septal defect

2020 ◽  
pp. 1-9
Author(s):  
Dong Zhao ◽  
Keming Yang ◽  
Wei Feng ◽  
Shoujun Li ◽  
Jun Yan ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Septal Defect ◽  
Pulmonary Atresia ◽  
Survival Curves ◽  
Major Aortopulmonary Collateral Arteries ◽  
Palliative Procedure ◽  
Collateral Arteries ◽  
Kaplan Meier ◽  
Aortopulmonary Collateral

Abstract Objective: This study aimed to investigate the association between long-term survival and different management of major aortopulmonary collateral arteries in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. Methods: From November, 2009 to October, 2018, a total of 98 consecutive patients with pulmonary atresia, ventricular septal defect, major aortopulmonary collateral arteries, and hypoplastic pulmonary arteries treated with modified Blalock–Taussig shunt or right ventricle–pulmonary artery connection were included. Fifty-five patients who received occlusion or ligation of major aortopulmonary collateral arteries during or after palliative procedure were occlusion group, and the other 43 patients were no occlusion group. The early and late outcomes were compared. Results: The mean duration of follow-up was 30.9 months in no occlusion group and 49.8 months in the occlusion group (p < 0.001). Multivariate analysis showed that only no occlusion of major aortopulmonary collateral arteries was predictive of total mortality (Hazard Ratio: 4.42, 95% CI: 1.27 to 15.42, p = 0.02). The Kaplan–Meier survival curves confirmed that patients without occlusion of major aortopulmonary collateral arteries demonstrated worse survival as compared with the occlusion group (p = 0.013). The Kaplan–Meier survival curves of patients who underwent different palliative procedures showed no differences. Conclusions: For patients with pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries when a primary repair is not feasible, those without occlusion of major aortopulmonary collateral arteries have a higher risk of death following an initial palliative procedure compared with patients who underwent occlusion of major aortopulmonary collateral arteries. The occlusion of major aortopulmonary collateral arteries is not associated with a higher rate of complete repair or better improvement of pulmonary artery growth.

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
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