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Intermediate outcomes of atrioventricular valvuloplasty in lateral tunnel Fontan patients.
J Heart Valve Dis. 2004 Nov; 13(6):962-71; discussion 971.JH

Abstract

BACKGROUND AND AIM OF THE STUDY

Lateral tunnel Fontan operation patients with atrioventricular valve (AVV) regurgitation have an increased incidence of Fontan failure (death, take-down or transplant). The outcomes of patients undergoing AVV repair during Fontan palliation were reviewed to determine the optimal technique and timing of repair.

METHODS

Hospital records for all patients with AVV regurgitation at the time of their Fontan procedure were reviewed retrospectively. Patients with staged single-ventricle palliation culminating in a lateral tunnel Fontan operation who had their first AVV repair at the Children's Hospital, Boston, were included. AVV regurgitation was graded by semi-quantitative color Doppler echocardiography on a scale of 1 to 4, as was ventricular dysfunction.

RESULTS

Among 859 lateral tunnel Fontan patients, 27 (3%) had a total of 30 AVV repairs (18 tricuspid, six mitral, six common AVV). Of the 27 first-time AVV repairs (16 TV, six MV, five CAVV), six were performed pre-Fontan, and 21 at or after Fontan. The median age at the first AVV repair was 3 years (range: 0.6-9.4 years). Preoperatively, the median echocardiographic severity of AVV regurgitation was grade 3 (range: 2-4). At median follow up of 1.2 years (range: 0-9.5 years) the severity of AVV regurgitation was reduced significantly to median grade 2 (range: 0-4; p <0.001). No patient with initial AVV repair at the time of Fontan underwent reoperation for AVV regurgitation. In all cases, ventricular function was maintained or improved, with preoperative median systemic ventricular function grade 1.5 (range: 1 to 4) versus postoperative grade 1 (range: 1-4; p = NS). There were no Fontan failures in the intermediate term.

CONCLUSION

AVV regurgitation and ventricular systolic function can be maintained or improved in the intermediate term following AVV repair in single-ventricle patients.

Authors+Show Affiliations

Department of Cardiac Surgery, Children's Hospital Boston, Boston, MA, USA. camillehf@hotmail.comNo 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

15597591

Citation

Hancock Friesen, Camille L., et al. "Intermediate Outcomes of Atrioventricular Valvuloplasty in Lateral Tunnel Fontan Patients." The Journal of Heart Valve Disease, vol. 13, no. 6, 2004, pp. 962-71; discussion 971.
Hancock Friesen CL, Sherwood MC, Gauvreau K, et al. Intermediate outcomes of atrioventricular valvuloplasty in lateral tunnel Fontan patients. J Heart Valve Dis. 2004;13(6):962-71; discussion 971.
Hancock Friesen, C. L., Sherwood, M. C., Gauvreau, K., Frank, D. F., del Nido, P. J., Jonas, R. A., Mayer, J. E., & Forbess, J. M. (2004). Intermediate outcomes of atrioventricular valvuloplasty in lateral tunnel Fontan patients. The Journal of Heart Valve Disease, 13(6), 962-71; discussion 971.
Hancock Friesen CL, et al. Intermediate Outcomes of Atrioventricular Valvuloplasty in Lateral Tunnel Fontan Patients. J Heart Valve Dis. 2004;13(6):962-71; discussion 971. PubMed PMID: 15597591.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intermediate outcomes of atrioventricular valvuloplasty in lateral tunnel Fontan patients. AU - Hancock Friesen,Camille L, AU - Sherwood,Megan C, AU - Gauvreau,Kimberley, AU - Frank,Derk F, AU - del Nido,Pedro J, AU - Jonas,Richard A, AU - Mayer,John E,Jr AU - Forbess,Joseph M, PY - 2004/12/16/pubmed PY - 2006/5/27/medline PY - 2004/12/16/entrez SP - 962-71; discussion 971 JF - The Journal of heart valve disease JO - J Heart Valve Dis VL - 13 IS - 6 N2 - BACKGROUND AND AIM OF THE STUDY: Lateral tunnel Fontan operation patients with atrioventricular valve (AVV) regurgitation have an increased incidence of Fontan failure (death, take-down or transplant). The outcomes of patients undergoing AVV repair during Fontan palliation were reviewed to determine the optimal technique and timing of repair. METHODS: Hospital records for all patients with AVV regurgitation at the time of their Fontan procedure were reviewed retrospectively. Patients with staged single-ventricle palliation culminating in a lateral tunnel Fontan operation who had their first AVV repair at the Children's Hospital, Boston, were included. AVV regurgitation was graded by semi-quantitative color Doppler echocardiography on a scale of 1 to 4, as was ventricular dysfunction. RESULTS: Among 859 lateral tunnel Fontan patients, 27 (3%) had a total of 30 AVV repairs (18 tricuspid, six mitral, six common AVV). Of the 27 first-time AVV repairs (16 TV, six MV, five CAVV), six were performed pre-Fontan, and 21 at or after Fontan. The median age at the first AVV repair was 3 years (range: 0.6-9.4 years). Preoperatively, the median echocardiographic severity of AVV regurgitation was grade 3 (range: 2-4). At median follow up of 1.2 years (range: 0-9.5 years) the severity of AVV regurgitation was reduced significantly to median grade 2 (range: 0-4; p <0.001). No patient with initial AVV repair at the time of Fontan underwent reoperation for AVV regurgitation. In all cases, ventricular function was maintained or improved, with preoperative median systemic ventricular function grade 1.5 (range: 1 to 4) versus postoperative grade 1 (range: 1-4; p = NS). There were no Fontan failures in the intermediate term. CONCLUSION: AVV regurgitation and ventricular systolic function can be maintained or improved in the intermediate term following AVV repair in single-ventricle patients. SN - 0966-8519 UR - https://www.unboundmedicine.com/medline/citation/15597591/Intermediate_outcomes_of_atrioventricular_valvuloplasty_in_lateral_tunnel_Fontan_patients_ L2 - https://antibodies.cancer.gov/detail/CPTC-KRAS4B-1 DB - PRIME DP - Unbound Medicine ER -