Modified hemi-Fontan operation: An alternative definitive palliation for high-risk patients
| Autor: | Christopher J. Knott-Craig, Ronald C. Elkins, Kent E. Ward, Tammi Fryar-Dragg, Jerry D. Razook, Edward D. Overholt |
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| Rok vydání: | 1995 |
| Předmět: |
Heart Defects
Congenital Pulmonary and Respiratory Medicine medicine.medical_specialty Asymptomatic law.invention Bidirectional Glenn procedure Postoperative Complications Risk Factors law medicine.artery medicine Cardiopulmonary bypass Humans business.industry Heart Bypass Right Palliative Care Infant medicine.disease Intensive care unit Thrombosis Surgery Pneumonia medicine.anatomical_structure Ventricle Child Preschool Anesthesia Pulmonary artery medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 60:S554-S557 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/0003-4975(95)00655-9 |
| Popis: | Background We conceptualized that by adding small amounts of prograde pulmonary blood flow to the hemi-Fontan operation, or bidirectional Glenn procedure, this modified hemi-Fontan operation could be safely done at an early age, with better oxygenation, and with less potential for pulmonary arteriovenous fistulae. Methods Since April 1992 the hemi-Fontan operation was modified by adding some prograde flow through the native pulmonary artery in 10 high-risk infants, either by leaving the critical subpulmonary stenosis untreated (n = 6) or by tightening a previously placed pulmonary artery band (n = 4). All other sources of pulmonary blood flow were interrupted. Patients were 4 to 23 months old (3.8 to 10.3 kg). Diagnoses included isolated dextrocardia with single ventricle (3) and polysplenia syndrome (2). Cardiopulmonary bypass was needed in 5 patients. Results There were no hospital deaths. Mean postoperative intensive care unit stay was 2 days, and 9 of 10 patients were discharged within 7 days of operation. One 4-month-old infant with Down's syndrome survived postoperative takedown of the hemi-Fontan repair after pneumonia and caval thrombosis developed. Eight patients are currently asymptomatic receiving minimal medication, and oxygen saturations range from 84% to 93%. Conclusions Adding small volumes of prograde pulmonary blood flow to the hemi-Fontan operation is safe, provides improved oxygenation, may encourage growth of central pulmonary arteries, and represent an alternative definitive palliation for high-risk Fontan candidates. |
| Databáze: | OpenAIRE |
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