scholarly journals Fontan Conversion for Patients with Protein-Losing Enteropathy after a Björk Procedure with Patent Right Atrium to Innominate Vein Bypass

2020 ◽  
Vol 49 (5) ◽  
pp. 257-260
Author(s):  
Shuichi Shiraishi ◽  
Ai Sugimoto ◽  
Masanori Tsuchida
Keyword(s):  
Right Atrium ◽  
Innominate Vein ◽  
Protein Losing Enteropathy ◽  
Vein Bypass ◽  
Fontan Conversion ◽  
Patent Right

Fontan conversion with hepatic vein exclusion: a means for hepatic preservation in single ventricle heart disease

2015 ◽  
Vol 26 (3) ◽  
pp. 582-585 ◽  
Author(s):  
Brian Kogon ◽  
Michael McConnell ◽  
Wendy Book
Keyword(s):  
Heart Disease ◽  
Single Ventricle ◽  
Venous Return ◽  
Venous Pressure ◽  
Premature Death ◽  
Liver Protein ◽  
Protein Losing Enteropathy ◽  
Anatomy And Physiology ◽  
Fontan Conversion

AbstractPatients with single ventricle heart disease often undergo staged surgical palliation, ultimately resulting in Fontan anatomy and physiology. Long-term consequences include cirrhosis of the liver, protein-losing enteropathy, and premature death. Elevated central venous pressure and venous congestion transmitted to the abdominal viscera have been implicated in the aetiology of many of these complications. We present a novel operation directed at protecting the liver and intestines by excluding the splanchnic venous return from the Fontan pathway. Instead of exposure to elevated Fontan pressures, the liver and intestines will be exposed to lower common atrial pressures. We hope that this modification will minimise the abdominal complications of Fontan anatomy and physiology.

Abstract 17017: Risk Prediction of Death and Failure in Patients With Atrio-pulmonary Connections: 40 Years Experience in Australia and New Zealand

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chin L Poh ◽  
Diana Zannino ◽  
Robert G Weintraub ◽  
David S Winlaw ◽  
Dorothy J Radford ◽  
...  
Keyword(s):  
New Zealand ◽  
Left Ventricular ◽  
Protein Losing Enteropathy ◽  
Severe Left Ventricular Dysfunction ◽  
Atrioventricular Valve Regurgitation ◽  
Increased Risk ◽  
Fontan Failure ◽  
Antiarrhythmic Medications ◽  
Fontan Conversion

Objective: To identify parameters predictive of death and failure in patients with an atrio-pulmonary connection Fontan. Methods: Retrospective analysis of long-term follow-up data using the Australia and New Zealand Fontan Registry Results: There were 245 patients surviving hospital discharge after an atriopulmonary Fontan from 1975 to 1994. At latest follow-up, 54 pts died, 29 underwent heart transplantation and 93 had Fontan failure (death, transplantation, Fontan conversion, protein losing enteropathy, severe left ventricular dysfunction on echocardiography or NYHA3). Twenty-eight years survival, freedom from death and transplantation and freedom from Fontan failure were respectively 62% (95%CI 55-71%), 58% (95% CI 50-67%) and 40% (95% CI 33-50%). Predictors of death and transplantation were dextrocardia (HR 1.8;p= 0.05), longer Fontan bypass time (HR= 1.01, p=0.05) and moderate or more late atrioventricular valve regurgitation (HR 3.97; p=0.02). One hundred and seven patients developed atrial arrhythmias, with first documented event at 15.7 years (IQR 10.5-19.3) post Fontan completion. Development of arrhythmia increased the likelihood of death or transplantation (HR 3.05, p<0.001) and Fontan failure (HR 4.7, p<0.001). Thromboembolic events occurred in 42 patients, 30 (71%) of whom were on warfarin but less than half (12/30) within therapeutic range. Thirty-nine patients underwent Fontan conversion. Threshold for conversion was lower in one center in which patients were operated earlier with better functional status, shorter history of arrhythmias and less antiarrhythmic medications. Conversion resulted in a reduced risk of Fontan failure (HR 0.48) in patients cared for by the center with lower conversion threshold but an increased risk in the remaining centres (HR 5.65) (p=0.023). Conclusions: Arrhythmias is an early sign predicting failure of the Fontan circulation of those with an atrio-pulmonary Fontan. Fontan conversion is only associated with improved outcomes when timely performed.

Very distal vein bypass in patients with thromboangiitis obliterans

VASA ◽  
2017 ◽  
Vol 46 (4) ◽  
pp. 304-309 ◽  
Author(s):  
Achim Neufang ◽  
Carolina Vargas-Gomez ◽  
Patrick Ewald ◽  
Nicolaos Vitolianos ◽  
Tolga Coskun ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Vein Graft ◽  
Duplex Ultrasound ◽  
Critical Limb Ischaemia ◽  
Thromboangiitis Obliterans ◽  
Surgical Revascularization ◽  
Autologous Vein ◽  
Therapeutic Concept ◽  
Autologous Vein Graft ◽  
Vein Bypass

Abstract. Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex findings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin configuration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superficial femoral artery was used for inflow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identified graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after definitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.

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