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Specific issues after extracardiac fontan operation: ventricular function, growth potential, arrhythmia, and thromboembolism.
Ann Thorac Surg. 2005 Aug; 80(2):665-72.AT

Abstract

BACKGROUND

The purpose of this study was to define the prevalence of specific sequelae after extracardiac Fontan operation.

METHODS

Sixty-five consecutive patients undergoing extracardiac Fontan operation were studied for mortality, Fontan failure, systemic ventricular function, supraventricular arrhythmias, thromboembolism, and growth potential. Age was 3 to 31 years (mean +/- standard deviation, 9.4 +/- 1.8; median, 7 years). The conduits were constructed of polytetrafluoroethylene (n = 50), and "viable" in situ pericardium (n = 15). The patients underwent serial echocardiogram, dynamic radionuclide studies, and cardiac catheterization.

RESULTS

Operative mortality was 3%, and the incidence of conduit thrombosis was 4.6%. There was paradoxic filling of the right lung after femoral injection of the radiotracer in all cases of conduit obstruction. Perioperative and late postoperative supraventricular arrhythmias were observed in 9.2% and 4.7% of patients, respectively. Risk factors for supraventricular arrhythmias included systemic ventricular dysfunction (p = 0.000), heterotaxy syndrome (p = 0.008), systemic venous anomalies (p = 0.015), and previous bidirectional Glenn operation (p = 0.017). At a mean follow-up of 77 +/- 2 months (range, 8 to 79 months), there were no late deaths (actuarial survival at 79 months, 96.9% +/- 0.02%). Serial echocardiograms demonstrated evidence of growth of the viable tunnels. Postoperatively, there was transient depression of ejection fraction in all patients (p = 0.000).

CONCLUSIONS

Supraventricular arrhythmias after extracardiac Fontan are more common in patients with heterotaxy syndrome, bilateral superior venae cavae, systemic ventricular dysfunction, and those undergoing completion Fontan operation. The viable tunnel may emerge as an optimal alternative by virtue of reduction of supraventricular arrhythmias, elimination of the need for anticoagulation, and addressing the issue of growth potential in selected patients.

Authors+Show Affiliations

Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. ujjwalchow@rediffmail.comNo 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)

Journal Article

Language

eng

PubMed ID

16039223

Citation

Chowdhury, Ujjwal K., et al. "Specific Issues After Extracardiac Fontan Operation: Ventricular Function, Growth Potential, Arrhythmia, and Thromboembolism." The Annals of Thoracic Surgery, vol. 80, no. 2, 2005, pp. 665-72.
Chowdhury UK, Airan B, Kothari SS, et al. Specific issues after extracardiac fontan operation: ventricular function, growth potential, arrhythmia, and thromboembolism. Ann Thorac Surg. 2005;80(2):665-72.
Chowdhury, U. K., Airan, B., Kothari, S. S., Talwar, S., Saxena, A., Singh, R., Subramaniam, G. K., Pradeep, K. K., Patel, C. D., & Venugopal, P. (2005). Specific issues after extracardiac fontan operation: ventricular function, growth potential, arrhythmia, and thromboembolism. The Annals of Thoracic Surgery, 80(2), 665-72.
Chowdhury UK, et al. Specific Issues After Extracardiac Fontan Operation: Ventricular Function, Growth Potential, Arrhythmia, and Thromboembolism. Ann Thorac Surg. 2005;80(2):665-72. PubMed PMID: 16039223.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Specific issues after extracardiac fontan operation: ventricular function, growth potential, arrhythmia, and thromboembolism. AU - Chowdhury,Ujjwal K, AU - Airan,Balram, AU - Kothari,Shyam Sundar, AU - Talwar,Sachin, AU - Saxena,Anita, AU - Singh,Rajvir, AU - Subramaniam,Ganapathy K, AU - Pradeep,Kizakke K, AU - Patel,Chetan D, AU - Venugopal,Panangipalli, PY - 2004/10/06/received PY - 2005/01/25/revised PY - 2005/02/01/accepted PY - 2005/7/26/pubmed PY - 2006/9/6/medline PY - 2005/7/26/entrez SP - 665 EP - 72 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 80 IS - 2 N2 - BACKGROUND: The purpose of this study was to define the prevalence of specific sequelae after extracardiac Fontan operation. METHODS: Sixty-five consecutive patients undergoing extracardiac Fontan operation were studied for mortality, Fontan failure, systemic ventricular function, supraventricular arrhythmias, thromboembolism, and growth potential. Age was 3 to 31 years (mean +/- standard deviation, 9.4 +/- 1.8; median, 7 years). The conduits were constructed of polytetrafluoroethylene (n = 50), and "viable" in situ pericardium (n = 15). The patients underwent serial echocardiogram, dynamic radionuclide studies, and cardiac catheterization. RESULTS: Operative mortality was 3%, and the incidence of conduit thrombosis was 4.6%. There was paradoxic filling of the right lung after femoral injection of the radiotracer in all cases of conduit obstruction. Perioperative and late postoperative supraventricular arrhythmias were observed in 9.2% and 4.7% of patients, respectively. Risk factors for supraventricular arrhythmias included systemic ventricular dysfunction (p = 0.000), heterotaxy syndrome (p = 0.008), systemic venous anomalies (p = 0.015), and previous bidirectional Glenn operation (p = 0.017). At a mean follow-up of 77 +/- 2 months (range, 8 to 79 months), there were no late deaths (actuarial survival at 79 months, 96.9% +/- 0.02%). Serial echocardiograms demonstrated evidence of growth of the viable tunnels. Postoperatively, there was transient depression of ejection fraction in all patients (p = 0.000). CONCLUSIONS: Supraventricular arrhythmias after extracardiac Fontan are more common in patients with heterotaxy syndrome, bilateral superior venae cavae, systemic ventricular dysfunction, and those undergoing completion Fontan operation. The viable tunnel may emerge as an optimal alternative by virtue of reduction of supraventricular arrhythmias, elimination of the need for anticoagulation, and addressing the issue of growth potential in selected patients. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/16039223/Specific_issues_after_extracardiac_fontan_operation:_ventricular_function_growth_potential_arrhythmia_and_thromboembolism_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(05)00268-7 DB - PRIME DP - Unbound Medicine ER -