Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-22T23:18:54.070Z Has data issue: false hasContentIssue false
  • English
  • Français

The Fontan operation with a fenestrated patch—rationale and results

Published online by Cambridge University Press:  19 August 2008

Aldo R. Castañeda  and
Nancy D. Bridges
Aldo R. Castañeda*
Affiliation:
Departments of Cardiovascular Surgery and Pediatric Cardiology, Children's Hospital and Harvard Medical School, Boston
Nancy D. Bridges
Affiliation:
Departments of Cardiovascular Surgery and Pediatric Cardiology, Children's Hospital and Harvard Medical School, Boston
*
Dr. Aldo R. Castañeda, Department of Cardiovascular Surgery, The Children's Hospital Medical Center, Longwood Street, Boston, MA 06213, USA.
Get access Rights & Permissions [Opens in a new window]

Abstract

A fenestration in the atrial septum may be temporarily beneficial in high–risk patients undergoing the modified Fontan operation. The venous system is decompressed into the left atrial cavities resulting in an improvement in the systemic output at the expense of a moderate arterial desaturation due to a right–to–left shunt. Two groups of patients undergoing the modified Fontan operation were compared. Those treated with the classic operation (non–fenestrated Fontan group, n=56) had lower prevalence of preoperative risk factors for the Fontan operation than those undergoing the Fontan operation with a fenestrated patch (n=91). Nevertheless, early results of mortality, repair take–down and morbidity (duration of pleuropericardial effusions) were comparable or better in the fenestrated Fontan group. By regression analysis the presence of a fenestrated patch was the major determinant in the reduction in the amount and duration of postoperative effusion. Of the early 73 survivors in the fenestrated Fontan group, fifty tolerated the closure of the fenestration, which occurred either spontaneously (five cases) or was achieved by a clamshell device during cardiac catheterization. Eleven patients failed the first attempt at fenestration closure, but this was successful at the second attempt a few months later. Coil embolization of arterial collaterals to the lung circulation and balloon dilatation of pulmonary artery stenoses were required in some cases. Other patients following the Fontan operation with a fenestrated patch showed an improvement of their ventricular function which was initially impaired. This favorable experience demonstrates the usefulness of the “fenestrated Fontan approach” in patients who are suboptimal candidates for the classic operation, provided that the preoperative risk factors are potentially reversible.

Keywords

Fontan operationfenestrated Fontanclamshell deviceright heart bypass
Type
Original Articles
Information
Cardiology in the Young , Volume 3 , Issue 3 , July 1993 , pp. 202 - 206
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Fontan, F, Kirklin, JW, Fern´ndez, G, Costa, F, Nafrel, DC, Tritto, F, Blackstone, EH. Outcome of a “perfect” Fontan operation. Circulation 1990; 81: 1520–1536.Google Scholar
2.Mayer, JE Jr, Bridges, ND, Lock, JE, Hanley, FL, Jonas, PA, Castaneda, AR. Factors associated with a marked reduction in mortality for Fonran operations in patients with single ven tricle. J Thorac Cardiovasc Surg 1992; 103: 444–452.Google Scholar
3.Laks, H, Haas, GS, Pearl, JM, Sadeghi, AM, George, BL, Santulli, TV, Williams, RG. The use of an adjustable interarrial communication in patients undergoing the Fontan and definitive heart procedures. Circulation 1988; 78 (Suppl II): II 357.[Abstract]Google Scholar
4.Bridges, ND, Lock, JE, Castañeda, AR. Baffle fenestratation with subsequent transcatheter closure. Modification of the Fontan operation for patients at increased risk. Circulation 1990; 82: 1681–1689.Google Scholar
5.Laks, H. The partial Fontan procedure. A new concept and its clinical application. Circulation 1990; 82: 1866–1867.Google Scholar
6.Stein, DG, Laks, H, Drinkwater, DC, Permut, LC, Louie, HW, Pearl, JM, George, BL, Williams, RG. Results of total cavopulmonary connection in the treatment of patients with a functional single ventricle. J Thorac Cardiovasc Surg 1991; 102: 280–287.Google Scholar
7.Jonas, RD, Castafleda, AR. Modified Fontan procedure: atrial baffle and systemic venous to pulmonary artery anastomotic techniques. J Card Surg 1988; 3: 91–96.Google Scholar
8.Mayer, JE Jr, Helgason, H, Jonas, RD, Lang, P, Vargas, FJ, Cook, N, Castañeda, AR. Extending the limits of modified Fontan procedures. J Thorac Cardiovasc Surg 1986; 92: 102 1–1028.CrossRefGoogle ScholarPubMed
9.Zellers, TM, Driscoll, DJ, Humes, PA, Feldt, RH, Puga, FJ, Danielson, GK. Glenn shunt. Effect on pleural drainage after modified Fontan operation. J Thorac Cardiovasc Surg 1989; 98: 725–729.Google Scholar
10.Bridges, ND, Jonas, RD, Mayer, JE Jr, Flanagan, MF, Keane, JF, Castaneda, AR. Bidirectional cavopulmonary anastomosis as interim palliation for high risk Fontan candidates. Early results. Circulation 1990; 82(Suppl IV) IV 170–IV 176.Google ScholarPubMed