Partial Fontan: Advantages of an adjustable interatrial communication
| Autor: | Gary S. Haas, Josephine Isabel-Jones, Roberta G. Williams, Jay M. Jarmakani, Barbara L. George, Davis C. Drinkwater, Jeffrey M. Pearl, Eli Milgalter, Hillel Laks |
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| Rok vydání: | 1991 |
| Předmět: |
Heart Defects
Congenital Male Pulmonary and Respiratory Medicine Cardiac output medicine.medical_specialty medicine.medical_treatment Pulmonary Artery law.invention Fontan procedure Dogs Postoperative Complications law medicine.artery Internal medicine mental disorders medicine Cardiopulmonary bypass Animals Humans Heart Atria Reactive airway disease business.industry Suture Techniques Prostheses and Implants medicine.disease Constriction Pulmonary hypertension Shunting medicine.anatomical_structure Child Preschool Anesthesia Hypertension Pulmonary artery Vascular resistance Cardiology Female Surgery Tricuspid Valve Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 52:1084-1095 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/0003-4975(91)91286-5 |
| Popis: | Systemic venous hypertension after the Fontan procedure is a major cause of mortality and morbidity, accounting for 11 of 16 deaths in our series of 228 Fontan procedures. A partial Fontan with a residual atrial septal defect (ASD) would allow controlled right-to-left shunting to reduce venous pressure and improve cardiac output while maintaining a reduced but acceptable arterial oxygen saturation. This allows complete or graded closure of the ASD after the discontinuation of cardiopulmonary bypass in the operating room or at any time in the postoperative period by exposing the snare under local anesthesia. From 1987 to 1990, 36 patients undergoing the modified Fontan procedure had placement of an adjustable interatrial communication. Indications for placement of an adjustable ASD included increased pulmonary artery pressures, increased pulmonary vascular resistance, reactive airway disease, previously increased or unknown pulmonary vascular resistance, small pulmonary arteries, and borderline ventricular function. Fourteen patients had the adjustable ASD closed at the time of operation, 8 patients underwent narrowing, and 12 underwent closure of the ASD in the postoperative period. Eight patients were discharged with the ASD partially open, and 2 patients underwent delayed closure. The partial Fontan with an adjustable ASD may increase the safety of the Fontan procedure for high-risk groups such as those with increased pulmonary vascular resistance, pulmonary hypertension, and impaired left ventricular function and for infants, who tolerate venous hypertension poorly. The ability to adjust the ASD in stages depending on the hemodynamic response increases flexibility and safety. |
| Databáze: | OpenAIRE |
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