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The failing Fontan circulation: successful conversion of atriopulmonary connections.
J Thorac Cardiovasc Surg. 2004 Jul; 128(1):60-6.JT

Abstract

OBJECTIVES

Symptoms from low cardiac output or refractory atrial arrhythmias are complicating atriopulmonary (classical) Fontan connections. We present our experience of converting such patients to total cavopulmonary connections with and without arrhythmia surgery.

METHODS

Between 1997 and 2002, 15 patients (mean age, 19.7 +/- 7.0 years) underwent conversion operations 12.7 +/- 3.5 years after atriopulmonary Fontan operations. Preoperative New York Heart Association functional class was I in 2 patients, II in 2 patients, III in 6 patients, and IV in 5 patients. Four patients underwent intracardiac lateral tunnel conversion alone, and 11 received extracardiac total cavopulmonary connection, right atrial reduction, and cryoablation.

RESULTS

No mortality occurred. One patient had conduit obstruction in the immediate postoperative period requiring replacement, and another required a redo operation for endocarditis. Average hospitalization was 17.9 +/- 9.38 days; chest drains were removed on median day 4 (range, 1-29; mean, 7.4 +/- 7.58 days). At follow-up (mean, 42.6 +/- 22.1 months), late atrial arrhythmias had recurred in 3 of 4 patients with intracardiac total cavopulmonary connections (without ablation) and 1 of 11 patients with extracardiac total cavopulmonary connections with ablation. All patients are in New York Heart Association class I or II. Exercise ability (Bruce protocol) improved 69% from a mean of 6.18 +/- 4.01 minutes to 10.45 +/- 2.11 minutes (P <.05). Need for antiarrhythmic agents decreased postoperatively (patients receiving < or =1 antiarrhythmic: 9 preoperatively vs 15 at long-term follow-up, P <.05). No patient has required transplantation. Protein-losing enteropathy, which was present in 1 patient, improved transiently with conversion. There was 1 late death from gastrointestinal hemorrhage.

CONCLUSIONS

Fontan conversion can be achieved with low mortality and improvement in New York Heart Association class and exercise ability. Concomitant arrhythmia surgery reduces the incidence of late arrhythmias.

Authors+Show Affiliations

Department of Cardiac Surgery, Wessex Regional Cardiac and Thoracic Unit, Southampton General Hospital, Southampton, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15224022

Citation

Sheikh, A M., et al. "The Failing Fontan Circulation: Successful Conversion of Atriopulmonary Connections." The Journal of Thoracic and Cardiovascular Surgery, vol. 128, no. 1, 2004, pp. 60-6.
Sheikh AM, Tang AT, Roman K, et al. The failing Fontan circulation: successful conversion of atriopulmonary connections. J Thorac Cardiovasc Surg. 2004;128(1):60-6.
Sheikh, A. M., Tang, A. T., Roman, K., Baig, K., Mehta, R., Morgan, J., Keeton, B., Gnanapragasam, J., Vettukattil, J. V., Salmon, A. P., Monro, J. L., & Haw, M. P. (2004). The failing Fontan circulation: successful conversion of atriopulmonary connections. The Journal of Thoracic and Cardiovascular Surgery, 128(1), 60-6.
Sheikh AM, et al. The Failing Fontan Circulation: Successful Conversion of Atriopulmonary Connections. J Thorac Cardiovasc Surg. 2004;128(1):60-6. PubMed PMID: 15224022.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The failing Fontan circulation: successful conversion of atriopulmonary connections. AU - Sheikh,A M, AU - Tang,A T M, AU - Roman,K, AU - Baig,K, AU - Mehta,R, AU - Morgan,J, AU - Keeton,B, AU - Gnanapragasam,J, AU - Vettukattil,J V, AU - Salmon,A P, AU - Monro,J L, AU - Haw,M P, PY - 2004/6/30/pubmed PY - 2004/8/13/medline PY - 2004/6/30/entrez SP - 60 EP - 6 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 128 IS - 1 N2 - OBJECTIVES: Symptoms from low cardiac output or refractory atrial arrhythmias are complicating atriopulmonary (classical) Fontan connections. We present our experience of converting such patients to total cavopulmonary connections with and without arrhythmia surgery. METHODS: Between 1997 and 2002, 15 patients (mean age, 19.7 +/- 7.0 years) underwent conversion operations 12.7 +/- 3.5 years after atriopulmonary Fontan operations. Preoperative New York Heart Association functional class was I in 2 patients, II in 2 patients, III in 6 patients, and IV in 5 patients. Four patients underwent intracardiac lateral tunnel conversion alone, and 11 received extracardiac total cavopulmonary connection, right atrial reduction, and cryoablation. RESULTS: No mortality occurred. One patient had conduit obstruction in the immediate postoperative period requiring replacement, and another required a redo operation for endocarditis. Average hospitalization was 17.9 +/- 9.38 days; chest drains were removed on median day 4 (range, 1-29; mean, 7.4 +/- 7.58 days). At follow-up (mean, 42.6 +/- 22.1 months), late atrial arrhythmias had recurred in 3 of 4 patients with intracardiac total cavopulmonary connections (without ablation) and 1 of 11 patients with extracardiac total cavopulmonary connections with ablation. All patients are in New York Heart Association class I or II. Exercise ability (Bruce protocol) improved 69% from a mean of 6.18 +/- 4.01 minutes to 10.45 +/- 2.11 minutes (P <.05). Need for antiarrhythmic agents decreased postoperatively (patients receiving < or =1 antiarrhythmic: 9 preoperatively vs 15 at long-term follow-up, P <.05). No patient has required transplantation. Protein-losing enteropathy, which was present in 1 patient, improved transiently with conversion. There was 1 late death from gastrointestinal hemorrhage. CONCLUSIONS: Fontan conversion can be achieved with low mortality and improvement in New York Heart Association class and exercise ability. Concomitant arrhythmia surgery reduces the incidence of late arrhythmias. SN - 0022-5223 UR - https://www.unboundmedicine.com/medline/citation/15224022/The_failing_Fontan_circulation:_successful_conversion_of_atriopulmonary_connections_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022522304002995 DB - PRIME DP - Unbound Medicine ER -