Fenestration Improves Clinical Outcome of the Fontan Procedure

Lemler, Matthew S.; Scott, William; Leonard, Steven; Stromberg, Daniel; Ramaciotti, Claudio

doi:10.1161/hc0202.102237

Cited by 254 publications

(54 citation statements)

References 21 publications

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“…(2,3) Subsequently, similar short term perioperative benefits of fenestration creation have been shown in a single center randomized study involving standard risk patients. (4) Although this procedure is now commonly performed, long-term benefits, if any, are not documented. Additionally, concerns remain about the need for later intervention to close the fenestration, as well as risks of persistent cyanosis and paradoxical embolization in patients with patent fenestrations.…”

Section: Introductionmentioning

confidence: 99%

Late Status of Fontan Patients With Persistent Surgical Fenestration

Atz

Travison

McCrindle

et al. 2011

Journal of the American College of Cardiology

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Objective To determine the effects of creation of a systemic to pulmonary venous atrial level communication (fenestration) at the time of the Fontan procedure on late outcomes. Background Fenestrations are frequently performed during Fontan procedures but late consequences are not well described. Methods Patient characteristics were compared between those with and without surgical fenestration among 536 subjects (mean 11.9 years) enrolled in the Pediatric Heart Network Fontan Cross-sectional Study. The status of the fenestration and the association of a currently patent fenestration with health status and measures of ventricular performance were investigated. Results Fenestration was performed in 361 patients (67%) and frequency differed by year and center (p<0.001 for each). After adjustment for center, age at Fontan, year of Fontan and prior superior cavopulmonary surgery, the fenestrated group had shorter length of Fontan hospital stay. At time of cross-sectional testing 8±3 years after Fontan, the fenestration remained open in 19% of subjects. Among those with confirmed fenestration closure, 59% were by catheter intervention, 1% by surgical intervention, and 40% had apparent spontaneous closure. Compared to those without evidence of a fenestration, subjects with a current fenestration were taking more medications (p=0.02) and had lower resting oxygen saturation (median 89 vs. 95%, p<.001). Functional health status, exercise performance, echocardiographic variables, prevalence of post Fontan stroke or thrombosis, and growth did not differ by current fenestration status. Discussion Surgical fenestration is associated with well demonstrated early postoperative benefits. This cross-sectional study found few associations between a persistent fenestration and deleterious later outcomes.

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Section: Introductionmentioning

confidence: 99%

Late Status of Fontan Patients With Persistent Surgical Fenestration

Atz

Travison

McCrindle

et al. 2011

Journal of the American College of Cardiology

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“…However, pulmonary and systemic circulations are well differentiated, as in the normal heart. If circulation is composed of a Fontan fenestration in the atrial septum [11] [12], there may be varying degrees of left-right shunt causing a mild systemic desaturation. In this unique circulation, the two principal determinants of long-term outcome are low pulmonary vascular resistance (PVR) and adequate singleventricle myocardial function.…”

Section: Perioperative Management Of Univentricular Heartsmentioning

confidence: 99%

Specific Injuries Management in the Postoperative of Congenital Heart Diseases (II): Univentricular Hearts

Andrés¹,

Miño²,

Diéguez³

et al. 2015

OJPed

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It is very important to understand that the univentricular heart surgery is just palliative, not being in anyway a definitive or curative surgery, but nowadays it's the best initial treatment of this complex heart disease. The fundamental philosophy of treatment of every univentricular heart is to ensure the flow system and/or restrict the lung flow. Thus, initially a patient with univentricular heart who is undergoing surgery may need to ensure systemic flow (reconstruction of the aortic arch type Norwood), to restrict the lung flow (pulmonary banding) or to provide enough pulmonary flow (pulmonary-systemic fistulae). However, some heart diseases with univentricular physiology remain "balanced" autonomously, until the "second" stage of palliation is performed (cavo-pulmonary anastomosis type Glenn), but others require performance of pulmonary banding, if there's no native lung protection and/or repair of the systemic circuit in a first stage, to reach next palliation steps in the best possible conditions.

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“…Although the fenestration allows a small right-to-left shunt and causes mild arterial desaturation, it increases cardiac output early postoperatively and reduces the duration of pleural drainage following surgery [144,145]. The fenestration can usually be closed percutaneously later in life to eliminate residual cyanosis [146].…”

Section: Fontan Circulationmentioning

confidence: 99%

Congenital Heart Defects in Adults : A Field Guide for Cardiologists

Romfh

Pluchinotta

Porayette³

et al. 2012

J Clin Exp Cardiolog

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Advances in cardiology and cardiac surgery allow a large proportion of patients with congenital heart defects to survive into adulthood. These patients frequently develop complications characteristic of the defect or its treatment. Consequently, adult cardiologists participating in the care of these patients need a working knowledge of the more common defects. Occasionally, patients with congenital heart defects such as atrial septal defect, Ebstein anomaly or physiologically corrected transposition of the great arteries present for the first time in adulthood. More often patients previously treated in pediatric cardiology centers have transitioned to adult congenital heart disease centers for ongoing care. Some of the more important defects in this category are tetralogy of Fallot, transposition of the great arteries, functionally single ventricle defects, and coarctation. Through this field guide, we provide an overview of the anatomy of selected defects commonly seen in an adult congenital practice using pathology specimens and clinical imaging studies. In addition, we describe the physiology, clinical presentation to the adult cardiologist, possible complications, treatment options, and outcomes.

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Fenestration Improves Clinical Outcome of the Fontan Procedure

Abstract: Background-The

Cited by 254 publications

References 21 publications

Late Status of Fontan Patients With Persistent Surgical Fenestration

Late Status of Fontan Patients With Persistent Surgical Fenestration

Specific Injuries Management in the Postoperative of Congenital Heart Diseases (II): Univentricular Hearts

Congenital Heart Defects in Adults : A Field Guide for Cardiologists

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