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Fontan completions over 10 years after Glenn procedures

Published online by Cambridge University Press:  27 March 2013

Koichi Sughimoto*
Affiliation:
Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
Kozo Matsuo
Affiliation:
Department of Cardiac Surgery, Chiba Cardiovascular Center, Ichihara, Japan Adult Congenital Heart Disease Program, Chiba Cardiovascular Center, Ichihara, Japan
Koichiro Niwa
Affiliation:
Department of Cardiology, St. Luke International Hospital, Tokyo, Japan
Yasutaka Kawasoe
Affiliation:
Department of Pediatrics, Chiba Cardiovascular Center, Ichihara, Japan
Shigeru Tateno
Affiliation:
Adult Congenital Heart Disease Program, Chiba Cardiovascular Center, Ichihara, Japan Department of Pediatrics, Chiba Cardiovascular Center, Ichihara, Japan
Takeaki Shirai
Affiliation:
Department of Cardiology, St. Luke International Hospital, Tokyo, Japan
Masashi Kabasawa
Affiliation:
Department of Cardiac Surgery, Chiba Cardiovascular Center, Ichihara, Japan
Masanao Ohba
Affiliation:
Department of Cardiac Surgery, Chiba Cardiovascular Center, Ichihara, Japan
*
Correspondence to: K. Sughimoto, Department of Cardiac Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne VIC 3052, Australia. Tel: 03 9345 5200; Fax: 03 9345 6386; E-mail: ksughimoto@gmail.com

Abstract

Objective: Despite the broadened indications for Fontan procedure, there are patients who could not proceed to Fontan procedure because of the strict Fontan criteria during the early period. Some patients suffer from post-Glenn complications such as hypoxia, arrhythmia, or fatigue with exertion long after the Glenn procedure. We explored the possibility of Fontan completion for those patients. Methods: Between 2004 and 2010, five consecutive patients aged between 13 and 31 years (median 21) underwent Fontan completion. These patients had been followed up for more than 10 years (10 to 13, median 11) after Glenn procedure as non-Fontan candidates. We summarise these patients retrospectively in terms of their pre-operative physiological condition, surgical strategy, and problems that these patients hold. Results: Pre-operative catheterisation showed pulmonary vascular resistance ranging from 0.9 to 3.7 (median 2.2), pulmonary to systemic flow ratio of 0.3 to 1.6 (median 0.9), and two patients had significant aortopulmonary collaterals. Extracardiac total cavopulmonary connections were performed in three patients, lateral tunnel total cavopulmonary connection in one patient, and intracardiac total cavopulmonary connection in one patient, without a surgical fenestration. Concomitant surgeries were required including valve surgeries – atrioventricular valve plasty in three patients and tricuspid valve replacement in one patient; systemic outflow tract obstruction release – Damus–Kaye–Stansel procedure in two patients and subaortic stenosis resection in one patient; and anti-arrhythmic therapies – maze procedure in two patients, cryoablation in two patients, and pacemaker implantation in two patients. All patients are now in New York Heart Association category I. Conclusion: Patients often suffer from post-Glenn complications. Of those, if they are re-examined carefully, some may have a chance to undergo Fontan completion and benefit from it. Multiple lesions such as atrioventricular valve regurgitation, systemic outflow obstruction, or arrhythmia should be surgically repaired concomitantly.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

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