Fontan Operation and the Cavopulmonary Technique: Immediate and Late Results According to the Presence of Atrial Fenestration

Atik, Edmar; Ikari, Nana Miura; Martins, Tamara Cortez; Barbero-Marcial, Miguel

doi:10.1590/s0066-782x2002000200004

Cited by 11 publications

(10 citation statements)

References 14 publications

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“…Dr G Kreutzer and colleagues from Argentina published their innovative work in the early 1970s and, along with Dr Fontan, set the technical surgical foundations for the operation subsequently known world wide as the Fontan–Kreutzer procedure 75. After Dr Kreutzer’s initial description, several modifications have been proposed and employed in South America, with evolving results 76777879808182838485. Creation of a fenestration is still debatable 82.…”

Section: Outcomes After Medical Surgical or Interventional Treatmentmentioning

confidence: 99%

“…After Dr Kreutzer’s initial description, several modifications have been proposed and employed in South America, with evolving results 76777879808182838485. Creation of a fenestration is still debatable 82. The Fontan–Kreutzer procedure is still a challenging operation and continues to stimulate surgeons and clinicians to broaden their clinical research in the field 82838485.…”

Section: Outcomes After Medical Surgical or Interventional Treatmentmentioning

confidence: 99%

“…Creation of a fenestration is still debatable 82. The Fontan–Kreutzer procedure is still a challenging operation and continues to stimulate surgeons and clinicians to broaden their clinical research in the field 82838485. There have been some interesting observations from centres in South America about ventricular remodelling in patients with tricuspid atresia before surgery86 and endothelial dysfunction before and after the Fontan–Kreutzer operation 8788…”

Section: Outcomes After Medical Surgical or Interventional Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Paediatric and congenital heart disease in South America: an overview

Pedra

Haddad²,

Pedra³

et al. 2009

Heart

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Congenital heart diseases are one of the most common structural defects present at birth, with an approximate incidence of 8 per 1000 live births. As most countries in South America have a high birth rate, they are a significant public health concern. This paper provides a brief overview of the burden of congenital heart disease in South America, focusing on its local prevalence, facilities for treatment and outcomes after medical, surgical or catheter intervention for the most common diseases.

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Section: Outcomes After Medical Surgical or Interventional Treatmentmentioning

confidence: 99%

Section: Outcomes After Medical Surgical or Interventional Treatmentmentioning

confidence: 99%

Section: Outcomes After Medical Surgical or Interventional Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Paediatric and congenital heart disease in South America: an overview

Pedra

Haddad²,

Pedra³

et al. 2009

Heart

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“…14 However, the right-to-left shunt at the atrial level results in cyanosis and functional exercise limitation. 15,16 Moreover, there is a risk of paradoxical thromboembolism from the passive Fontan circulation via the fenestration to the systemic circulation. Therefore, routine Fontan fenestration is not performed at our institution for lateral tunnel or extracardiac Fontan and is reserved for selected patients with elevated pulmonary vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

Fontan Operation and the Single Ventricle

Aboulhosn

Shavelle

Castellon

et al. 2007

Congenital Heart Disease

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The Fontan operation has gone through multiple incarnations since Fontan and Baudet's initial description in 1971. Through the medical dossier of a patient with a single ventricle, we plot the history of medical, surgical, and percutaneous interventions over the past 40 years, specifically focusing on the Fontan procedure, its development, indications, sequelae, and complications. Cardiac computed tomography with angiography is highlighted as a noninvasive imaging tool for the evaluation of the complex Fontan circulation.

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“…Universidade de São Paulo, the standardization of an early indication has not been made in most of the situations, and in 41 patients undergoing cavopulmonary connection with atrial fenestration, mean age of 7.6±4.6 years, and in other 21 additional patients without atrial fenestration, mean age of 7.3±3.4 years, the outcome has proven adequate (57 out of the 62 patients in functional class I) in a mean follow-up period of 3.1±2.4 and 5.1±3.3 years, respectively, in the two groups 15 .…”

Section: At Instituto Do Coração Da Faculdade De Medicina Damentioning

confidence: 90%

Operação de Fontan: reflexões da evolução e perspectivas atuais

Atik¹

2006

Arq. Bras. Cardiol.

Self Cite

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Fontan, congenital heart diseases, surgery.As the Fontan operation 1 became the most frequently performed surgery in Pediatric Cardiology for the functional correction of many congenital heart diseases with singleventricle physiology, it started to be considered in relation to the most suitable maneuvers to minimize the complications that still challenge its management in the long term.Although the incidence of such complications has decreased mainly as from 1988 with the introduction of the total cavopulmonary technique 2 , we can still observe the occurrence of morbidity elements whose rates are disturbing and affect the evolution of this method.Because of the dynamics imposed on the new anatomic situation with the cavopulmonary connection which eliminates the pulsatile function of the right ventricle and establishes the slow venous flow through the venae cavae to the pulmonary arterial tree, the occurrence of complications resulting from congestive, electrical and thromboembolic aspects is thus facilitated.The congestive aspects are characterized by increased venous pressure, hepatomegaly, protein-losing enteropathy due to lymphangiectasia, lower-extremity edema, and ascitis.The electrical aspects concern both the decrease in sinus automatism and supraventricular arrhythmias such as extrasystoles, fibrillation, and paroxysmal tachycardias.The thromboembolic aspects, which start in the venous system and in venous-arterial junctions and conduit connections, are also related to the occurrence of several coagulation disorders caused by factors resulting from liver congestion.Pathogenic factors of these adverse elements are related to preoperative anatomic and functional aspects and that is why a more accurate analysis of these aspects is mandatory at the moment of the surgical procedure.In this setting, it is well timed to recall and mention the factors considered optimal for the surgical indication, which are mainly: preserved ventricular function close to normal, adequate pulmonary arterial tree with mean pressures below 15 mmHg and pulmonary resistance lower than 2U Wood, and also the presence of sinus rhythm responsive to stimuli 3 . Absence of atrioventricular and aortic regurgitation, of fistulae and systemic-pulmonary anastomotic vessels, in addition to myocardial hypertrophy are also included.These deleterious factors are effectively responsible for the mortality that occurs throughout time and which ranges, according to the expertise of each medical center, from 15 to 30% 15 years after the surgical procedure 3 . That is where death results from, mainly related to heart failure, arrhythmias, thromboembolism, and to protein-losing syndrome.Among the complications, those with the highest prevalence and repercussion are heart failure and arrhythmias, mainly in atriopulmonary 4-6 techniques, but also in cavopulmonary 7 procedures when performed in adulthood. These complications are less frequent in cavopulmonary connections with extracardiac conduits 8 than in intra-atrial lateral tunnel 7,9 . Other complica...

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Fontan Operation and the Cavopulmonary Technique: Immediate and Late Results According to the Presence of Atrial Fenestration

Cited by 11 publications

References 14 publications

Paediatric and congenital heart disease in South America: an overview

Paediatric and congenital heart disease in South America: an overview

Fontan Operation and the Single Ventricle

Operação de Fontan: reflexões da evolução e perspectivas atuais

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