Comparison of lateral tunnel and extracardiac conduit Fontan procedure

Lee, Jeong Ryul; Kwak, JaeGun; Kim, Kwan Chang; Min, Suhong; Kim, Yong Jin; Rho, Jeong Ok

doi:10.1510/icvts.2006.146928

Cited by 39 publications

(15 citation statements)

References 10 publications

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“…Based on the several clinical, in vivo and in vitro flow studies,19 two contemporary surgical templates, namely intra-atrial lateral tunnel and extra-cardiac TCPC are now the current final-stage (S3R) surgical procedures of choice 1,28,48. The hemodynamic advantage of one surgical template type over the other is a critical long-asked clinical question 11,29. However a definite conclusion is challenged due to patient-to-patient variations in congenital heart disease, univentricle heart function,50 preload, afterload, pulmonary, hepatic venous physiology, and respiratory pump.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Performance of Stage-2 Univentricular Reconstruction: Glenn vs. Hemi-Fontan Templates

et al. 2008

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Flow structures, hemodynamics and the hydrodynamic surgical pathway resistances of the final stage functional single ventricle reconstruction, namely the total cavopulmonary connection (TCPC) anatomy, have been investigated extensively. However, the second stage surgical anatomy (i.e., bi-directional Glenn or hemi-Fontan template) has received little attention. We thus initiated a multi-faceted study, involving magnetic resonance imaging (MRI), phase contrast MRI, computational and experimental fluid dynamics methodologies, focused on the second stage of the procedure. Twenty three-dimensional computer and rapid prototype models of 2nd stage TCPC anatomies were created, including idealized parametric geometries (n = 6), patient-specific anatomies (n = 7), and their virtual surgery variant (n = 7). Results in patient-specific and idealized models showed that the Glenn connection template is hemodynamically more efficient with (83% p = 0.08 in patient-specific models and 66% in idealized models) lower power losses compared to hemi-Fontan template, respectively, due to its direct end-to-side anastomosis. Among the several secondary surgical geometrical features, stenosis at the SVC anastomosis or in pulmonary branches was found to be the most critical parameter in increasing the power loss. The pouch size and flare shape were found to be less significant. Compared to the third stage surgery the hydrodynamic resistance of the 2nd stage is considerably lower (both in idealized models and in anatomical models at MRI resting conditions) for both hemi- and Glenn templates. These results can impact the surgical design and planning of the staged TCPC reconstruction.

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Section: Introductionmentioning

confidence: 99%

Hemodynamic Performance of Stage-2 Univentricular Reconstruction: Glenn vs. Hemi-Fontan Templates

et al. 2008

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“…The incidence of arrhythmias has come down significantly after the introduction of the total cavopulmonary connection technique. 4 Fortunately, our patient did not have an episode of arrhythmia during her entire hospital stay, nor had a history of palpitations before admission.…”

Section: Cardiac Complicationsmentioning

confidence: 78%

Twin pregnancy in a Fontan-palliated patient

2016

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The Fontan connection, originally described in 1971, is used to provide palliation for patients with many forms of CHDs that cannot support a biventricular circulation. An increasing number of females who have undergone these connections in childhood are now surviving into adulthood and some are becoming pregnant. We report a case of a 29-year-old woman who presented with a twin pregnancy at 33 weeks of gestation. She had significant deterioration of her cardiovascular status before the twin babies were delivered by emergency caesarean section owing to associated obstetric complications. This report also highlights the various maternal and fetal complications occurring in pregnancy of Fontan-palliated patients and suggests the need for meticulous pre-conception counselling and strict perinatal care.

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“…There were two hundred thirty‐nine English articles and three hundred eighty‐eight Chinese articles were initially identified (Figure ). All of the 10 articles that were finally included in the systematic review were retrospective cohort studies written in English languages. All the references of included studies were reviewed, however, none met the inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

“…Nakano's study 22 did not report the exact number of people underwent ACC. Some studies 19,20,23,25 used median (quartile) approach while other studies 18,[21][22][23][24]26 used mean 6 standard deviation to report the time of CBP and ACC ( Table 2). It showed that the heterogeneity of CBP (P 5 .02, I 2 5 64%) and ACC (P < .001, I 2 5 97%) was large among groups.…”

Section: Surgical-related Eventsmentioning

confidence: 99%