Fontan procedure for tricuspid atresia.

Gale, Alan W.; Danielson, Gordon K.; McGoon, Dwight C.; Wallace, Robert B.; Mair, Douglas D.

doi:10.1161/01.cir.62.1.91

Cited by 100 publications

(15 citation statements)

References 12 publications

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“…Gale et al, however, operated on 18 patients who did not fulfil the Fontan criteria, 78% of whom survived. 13 In addition, they successfully repaired five patients with tricuspid atresia type C, in whom the pulmonary artery had been banded. In order to assess more precisely how the structure of the pulmonary vasculature may affect the outcome of a Fontan repair, the lungs should be examined histologically at the time of repair in a large series of patients in whom the pressure gra-dient across the pulmonary vascular bed and the cardiac output are closely monitored postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary vascular structure in patients dying after a Fontan procedure. The lung as a risk factor.

Juaneda¹,

Haworth²

1984

Heart

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SUMMARY Pulmonary vascular structure was analysed in the lungs of 12 patients who had had a Fontan repair, 11 of whom died. Of the eight patients with a low pulmonary blood flow preoperatively, pulmonary vascular structure was almost normal in seven, but in the remaining patient many intra-acinar arteries contained organised occlusive thrombi. Of the four patients with an increased pulmonary blood flow immediately before operation, there was a significant increase in pulmonary vascular smooth muscle despite three of the patients having had a pulmonary arterial band. The findings suggest that it is more difficult for patients with an increased pulmonary blood flow to fulfil the Fontan criteria for repair, and even when the pulmonary vascular resistance is <4 units/M2 there may be significant pulmonary vascular abnormalities likely to increase right atrial afterload and prejudice the outcome of a Fontan repair.The Fontan procedure, connection of the right atrium either to the pulmonary artery directly or via a subpulmonary ventricular chamber, provides a physiological correction for tricuspid atresia and other types of double inlet ventricle. '-5 Pulmonary blood flow is dependent on the gradient between right and left atrial pressures, and so pulmonary vascular resistance must be as low as possible.6 Immediately after operation any increase in right atrial afterload increases right atrial pressure until leakage occurs in the systemic capillaries. The selection criteria for a Fontan procedure demand that the mean pulmonary arterial pressure be --15 mm Hg, pulmonary vascular resistance be <4 units/M2, and that the ratio of the diameter of the main pulmonary artery to that of the aorta be ¢e0.75 with normal sized pulmonary arteries.7 The pulmonary vascular bed may, however, have been compromised by palliative surgery in patients whose intracardiac anatomy is theoretically suitable for a Fontan repair. The clinical condition of most children with tricuspid atresia demands that a systemic-pulmonary anastomosis be performed before they reach the recommended age for a Fontan procedure of 4 years.7 Shunt operations may be compliRequests for reprints to

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Section: Discussionmentioning

confidence: 99%

Pulmonary vascular structure in patients dying after a Fontan procedure. The lung as a risk factor.

Juaneda¹,

Haworth²

1984

Heart

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“…In four of our patients, the dynamic radionuclide studies detected persistent right-to-left shunting, a known complication after the Fontan procedure [3,6,8]. These four patients had associated Glenn anastomoses.…”

Section: Right-to-left Shuntmentioning

confidence: 69%

“…The Fontan procedure was first described in 1 971 [1 , 2] and became widely used for "physiologic" correction of tricuspid atresia [3][4][5][6][7][8]. This operation has also been used increasingly for other complex cyanotic congenital cardiac diseases [5,9].…”

mentioning

confidence: 99%

Radionuclide studies in postoperative evaluation of the Fontan procedure

Brendel¹,

Wynchank²,

Choussat³

et al. 1984

American Journal of Roentgenology

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“…55,87,100 This involves disconnecting the pulmonary artery from the left ventricle and anastomosing it to the right atrium via a valved conduit and closure of the atrial septal defect ( Figure 4A). After this operation, the left ventricle has to pump the blood into the aorta via the VSD and right ventricle.…”

Section: Surgical Implicationsmentioning

confidence: 99%

“…Although the patients with tricuspid atresia with transposition operated on by Fontan and others survived, a patient similarly treated by Ross and Somerville died of low cardiac output in the immediate postoperative period. 57,87,100 This was attributed to subaortic obstruction caused by a small ventricular septal defect. 57 Three of our cases (Cases 12-14) had pressure and/or angiographic evidence for obstruction at the VSD level (Table 3).…”

Section: Surgical Implicationsmentioning

confidence: 99%

The Ventricular Septal Defect in Tricuspid Atresia: Its Natural History and Surgical Importance

Rao

1983

Ann Saudi Med

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We have previously reported anatomic and functional closure of ventricular septal defects (VSDs) in tricuspid atresia. To study this phenomenon further, clinical, angiographic, and pathologic findings in 40 consecutive cases of tricuspid atresia were reviewed. In 14 of these patients, there was evidence of closure of the VSD; in eight it was complete and in the other six partial. Eleven of these VSD closures occurred in type 1 (without transposition) patients and three among type II (with transposition). Progressive cyanosis, increasing polycythemia and/or disappearance of a previously heard murmur were observed in all patients; these signs were more conspicuous in complete than in partial closure. The incidence of closure of VSD in this lesion was 35 percent but when tricuspid atresia patients without VSD are excluded, the incidence increases to 42 percent. Progressive muscular "encroachment" of the margins of the VSD with subsequent fibrosis and covering by endocardial proliferation is the most likely mechanism of closure. Previous surgical shunts played no role in VSD closure. For initial palliation, a Blalock-Taussig shunt (preferably on the left side) is recommended in preference to a Glenn anastomosis, because the latter may leave the left pulmonary circuit without blood supply if the VSD closes. If further palliation is required prior to a Fontan type of operation, a Blalock-Taussig shunt on the right side, Glenn anastomosis or enlargement of VSD could be performed. In type II patients, a large and non-restrictive VSD is essential for survival following a Fontan operation. Therefore, the size of the VSD should be evaluated prior to and at the time of surgical correction. If the VSD is small in type II cases, complete bypass of the VSD and right ventricle either by a pulmonary artery-to-ascending aorta or left ventricle-to-descending aorta conduit should be performed. This is preferable to resection of the ventricular septum or creation of an aortopulmonary window proximal to pulmonary artery banding.

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Fontan procedure for tricuspid atresia.

Cited by 100 publications

References 12 publications

Pulmonary vascular structure in patients dying after a Fontan procedure. The lung as a risk factor.

Pulmonary vascular structure in patients dying after a Fontan procedure. The lung as a risk factor.

Radionuclide studies in postoperative evaluation of the Fontan procedure

The Ventricular Septal Defect in Tricuspid Atresia: Its Natural History and Surgical Importance

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