Original articlePediatric cardiacHypoplastic Left Heart Syndrome: Feasibility Study for Patients Undergoing Completion Fontan at or Prior to Two Years of Age
Section snippets
Study Design
The Heart Institute for Children's database was retrospectively reviewed and analyzed. All patients who had undergone CF after Norwood operation and bidirectional Glenn for HLHS from August 1999 to December 2008 were included. Patients classified as single ventricle anatomy other than HLHS were excluded (including unbalanced atrioventricular septal defect, double outlet right ventricle with mitral and (or) aortic atresia, or heterotaxy syndrome). Only patients with a hypoplastic left ventricle
Results
The pre-CF catheter interventions performed included coil occlusion of systemic-pulmonary collaterals or pulmonary arteriovenous malformation and balloon dilatation of pulmonary arteries (Table 2). Pre-CF main pulmonary artery diameter, MGr, and TPG were 7.94 ± 0.59 mm, 1.79 ± 0.2, and 4.1 ± 1.1 mm Hg for group A compared with 7.87 ± 0.58 mm, 1.77 ± 0.19, and 3.5 ± 0.9 mm Hg for group B (p = NS), respectively (Table 2). The pulmonary resistance to systemic resistance ratio and pulmonary
Comment
Better understanding of the natural history and anatomic morphology of HLHS, advances in surgical techniques and intraoperative myocardial protection, and comprehensive postoperative management have contributed to a remarkable improvement in early and late mortality, before and after CF [5, 6, 7, 8, 9, 10]. However, elimination of cyanosis and right ventricle unloading from systemic and pulmonary circulation by CF at an earlier age remains a controversial topic. Volume unloading can be evident
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Pathophysiology of thrombosis and anticoagulation post Fontan surgery
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2016, Annals of Thoracic SurgeryCitation Excerpt :The patients included 7 males and 5 females. The Fontan operations were performed in our institute prior to 2 years of age to accomplish early unloading of the main ventricle and early relief from cyanosis [20]. The ages at the time of the operation ranged from 1.0 to 1.6 years of age and the ages at the time of catheterization ranged from 2.0 to 2.9 years of age.
Influence of pulmonary artery size on early outcome after the fontan operation
2014, Annals of Thoracic SurgeryCitation Excerpt :These findings support our approach not to perform pre-Fontan PA augmentation procedures, including creation or leaving of aortopulmonary shunts during the second-stage procedure, even in patients with very small PAs, at the expense of an additional ventricular load. Of Choussat's 10 commandments for a successful univentricular palliation, nowadays ventricular function and the status of the pulmonary vasculature seem to be the most concerning issues before the FO [9, 17, 21]. According to our results, smaller PA diameters measured using McGoon ratio and Nakata index do not adversely influence the Fontan palliation's early outcome.
Impact of postoperative hemodynamics in patients with functional single ventricle undergoing fontan completion before weighing 10 Kg
2012, Annals of Thoracic SurgeryCitation Excerpt :However elimination of cyanosis and ventricle unloading from the systemic and pulmonary circulation by Fontan operation at an earlier age remains a controversial topic. However volume unloading can be evident when there is collateral accessory flow between the systemic circulation and the pulmonary circulation [11]. More recent approaches to Fontan completion include volume-unloading operations at a younger age to reduce the adverse effects of prolonged ventricular volume overload on ventricular function.
Shunt reintervention and time-related events after norwood operation: Impact of shunt strategy
2012, Annals of Thoracic SurgeryCitation Excerpt :Furthermore, this RV-to-PA modification might help reducing the diastolic flow reversal into the RV postoperatively, allowing some early diastolic ventricular relaxation of an already compromised RV from the interplay with the adjacent noncompliant LV. Furthermore, S2P at younger age is not associated with increased perioperative mortality, morbidity, or intensive care unit length of stay [16, 30]. We observed no difference in outcomes between the groups at BDG.
The Fontan Procedure: Evolution in Technique; Attendant Imperfections and Transplantation for "Failure"
2011, Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery AnnualCitation Excerpt :While a small amount of atrium remains in the circuit to provide growth potential, atrial tissue is minimized to theoretically reduce the risk of dilatation and arrhythmia. The growth potential of this design has led many groups to routinely offer the Fontan procedure to patients as young as 18 months of age.11 Other potential advantages include reduced risk of thrombosis as a result of less stasis, better myocardial venous drainage because the coronary sinus remains in the lower pressure pulmonary venous atrium, and a more reliable (intracardiac) fenestration.