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Revision of previous Fontan connections to extracardiac or intraatrial conduit cavopulmonary anastomosis.
Ann Thorac Surg. 1996 Nov; 62(5):1276-82; discussion 1283.AT

Abstract

BACKGROUND

In patients who have received an atriopulmonary Fontan connection, complications such as right pulmonary vein obstruction, atrial arrhythmias, and thromboembolism are often secondary to right atrial enlargement. When such complications develop despite good ventricular function, there are few management options available. Extracardiac or intraatrial conduit cavopulmonary anastomosis, which improves central systemic venous flow patterns, avoids atrial distention, and does not involve the extensive atrial suturing required by other forms of cavopulmonary anastomosis, may provide relief for this group of patients.

METHODS

Between October 1992 and October 1995, 7 patients presented 8 to 20 years after atriopulmonary connection with severe right atrial dilatation (7), Fontan pathway obstruction (4), progressive congestive heart failure (4), atrial tachydysrhythmias (3), right atrial thrombus (1), obstruction of right pulmonary veins by an enlarged right atrium (1), and subaortic stenosis (1). After evaluation of the options, they underwent revision of the atriopulmonary connection to extracardiac (5) or intraatrial (2) conduit cavopulmonary anastomosis.

RESULTS

One patient with severe cachexia, in whom transplantation was contraindicated for social reasons, died in the early postoperative period of massive effusions. Two patients eventually required permanent pacing for atrial dysrhythmias (1) or complete heart block secondary to subaortic fibromuscular resection (1), and 2 demonstrated marked improvement in unstable preoperative rhythm disturbances. At a median follow-up of 17 months, 4 of the 6 survivors were functioning at higher New York Heart Association levels than preoperatively, and 1 had recently undergone heart transplantation.

CONCLUSIONS

In properly selected patients with atrial complications, revision of a prior Fontan connection to extracardiac or intraatrial conduit cavopulmonary anastomosis appears to be a viable option.

Authors+Show Affiliations

Division of Cardiothoracic Surgery, University of California, San Francisco, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8893557

Citation

McElhinney, D B., et al. "Revision of Previous Fontan Connections to Extracardiac or Intraatrial Conduit Cavopulmonary Anastomosis." The Annals of Thoracic Surgery, vol. 62, no. 5, 1996, pp. 1276-82; discussion 1283.
McElhinney DB, Reddy VM, Moore P, et al. Revision of previous Fontan connections to extracardiac or intraatrial conduit cavopulmonary anastomosis. Ann Thorac Surg. 1996;62(5):1276-82; discussion 1283.
McElhinney, D. B., Reddy, V. M., Moore, P., & Hanley, F. L. (1996). Revision of previous Fontan connections to extracardiac or intraatrial conduit cavopulmonary anastomosis. The Annals of Thoracic Surgery, 62(5), 1276-82; discussion 1283.
McElhinney DB, et al. Revision of Previous Fontan Connections to Extracardiac or Intraatrial Conduit Cavopulmonary Anastomosis. Ann Thorac Surg. 1996;62(5):1276-82; discussion 1283. PubMed PMID: 8893557.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Revision of previous Fontan connections to extracardiac or intraatrial conduit cavopulmonary anastomosis. AU - McElhinney,D B, AU - Reddy,V M, AU - Moore,P, AU - Hanley,F L, PY - 1996/11/1/pubmed PY - 1996/11/1/medline PY - 1996/11/1/entrez SP - 1276-82; discussion 1283 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 62 IS - 5 N2 - BACKGROUND: In patients who have received an atriopulmonary Fontan connection, complications such as right pulmonary vein obstruction, atrial arrhythmias, and thromboembolism are often secondary to right atrial enlargement. When such complications develop despite good ventricular function, there are few management options available. Extracardiac or intraatrial conduit cavopulmonary anastomosis, which improves central systemic venous flow patterns, avoids atrial distention, and does not involve the extensive atrial suturing required by other forms of cavopulmonary anastomosis, may provide relief for this group of patients. METHODS: Between October 1992 and October 1995, 7 patients presented 8 to 20 years after atriopulmonary connection with severe right atrial dilatation (7), Fontan pathway obstruction (4), progressive congestive heart failure (4), atrial tachydysrhythmias (3), right atrial thrombus (1), obstruction of right pulmonary veins by an enlarged right atrium (1), and subaortic stenosis (1). After evaluation of the options, they underwent revision of the atriopulmonary connection to extracardiac (5) or intraatrial (2) conduit cavopulmonary anastomosis. RESULTS: One patient with severe cachexia, in whom transplantation was contraindicated for social reasons, died in the early postoperative period of massive effusions. Two patients eventually required permanent pacing for atrial dysrhythmias (1) or complete heart block secondary to subaortic fibromuscular resection (1), and 2 demonstrated marked improvement in unstable preoperative rhythm disturbances. At a median follow-up of 17 months, 4 of the 6 survivors were functioning at higher New York Heart Association levels than preoperatively, and 1 had recently undergone heart transplantation. CONCLUSIONS: In properly selected patients with atrial complications, revision of a prior Fontan connection to extracardiac or intraatrial conduit cavopulmonary anastomosis appears to be a viable option. SN - 0003-4975 UR - https://www.unboundmedicine.com/medline/citation/8893557/Revision_of_previous_Fontan_connections_to_extracardiac_or_intraatrial_conduit_cavopulmonary_anastomosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0003-4975(96)00567-X DB - PRIME DP - Unbound Medicine ER -