TY - JOUR
T1 - Palliation of complex cardiac anomalies with subaortic obstruction
T2 - New operative approach
AU - Di Donato, Roberto
AU - Di Carlo, Duccio C.
AU - Giannico, Salvatore
AU - Marcelletti, Carlo
PY - 1989
Y1 - 1989
N2 - The modified Fontan operation for complex cardiac anomalies associated with subaortic obstruction entails a high surgical risk. It is likely that ventricular hypertrophy secondary to chronic pressure overload plays a significant role. This problem was approached with a new type of palliative operation comprising both a proximal pulmonary artery to ascending aorta anastomosis and a bidirectional cavopulmonary anastomosis. This operation was performed in six children ranging in age from 26 to 63 months. There was one intraoperative death due to hemorrhage. In one patient, a pulmonary to aorta conduit caused compression of the right coronary artery; the problem was solved by lengthening the conduit with a second period of cardiopulmonary bypass. The five survivors experienced an uneventful postoperative course. Repeat cardiac catheterization in these five patients showed low pressure in the cavopulmonary system (mean 10 mm Hg), absence of a gradient at rest between the systemic ventricle and aorta and fair arterial oxygenation (mean 82%). A technetium-99m perfusion lung scan visualized a slight prevalence of pulmonary blood flow ipsilateral to the shunt in three cases, whereas in one case preferential flow to the right lung was associated with a narrowing at the site of the cavopulmonary anastomosis. Mild hypoperfusion of the anterior pulmonary segments was observed in two cases. Both pressure and volume overload are abolished with this procedure and a satisfactory oxygenation is provided. Low venous pressure in the coronary, hepatic and renal areas as well as the short bypass time may explain the smoothness of the postoperative course in our patients. It is conceivable that oxygenation can be improved by a modified Fontan operation at a lower operative risk than is obtained with a single stage procedure because of regression of ventricular hypertrophy. Long-term follow-up indicates the value of this operation as a form of definitive palliation.
AB - The modified Fontan operation for complex cardiac anomalies associated with subaortic obstruction entails a high surgical risk. It is likely that ventricular hypertrophy secondary to chronic pressure overload plays a significant role. This problem was approached with a new type of palliative operation comprising both a proximal pulmonary artery to ascending aorta anastomosis and a bidirectional cavopulmonary anastomosis. This operation was performed in six children ranging in age from 26 to 63 months. There was one intraoperative death due to hemorrhage. In one patient, a pulmonary to aorta conduit caused compression of the right coronary artery; the problem was solved by lengthening the conduit with a second period of cardiopulmonary bypass. The five survivors experienced an uneventful postoperative course. Repeat cardiac catheterization in these five patients showed low pressure in the cavopulmonary system (mean 10 mm Hg), absence of a gradient at rest between the systemic ventricle and aorta and fair arterial oxygenation (mean 82%). A technetium-99m perfusion lung scan visualized a slight prevalence of pulmonary blood flow ipsilateral to the shunt in three cases, whereas in one case preferential flow to the right lung was associated with a narrowing at the site of the cavopulmonary anastomosis. Mild hypoperfusion of the anterior pulmonary segments was observed in two cases. Both pressure and volume overload are abolished with this procedure and a satisfactory oxygenation is provided. Low venous pressure in the coronary, hepatic and renal areas as well as the short bypass time may explain the smoothness of the postoperative course in our patients. It is conceivable that oxygenation can be improved by a modified Fontan operation at a lower operative risk than is obtained with a single stage procedure because of regression of ventricular hypertrophy. Long-term follow-up indicates the value of this operation as a form of definitive palliation.
UR - http://www.scopus.com/inward/record.url?scp=0024535071&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0024535071&partnerID=8YFLogxK
U2 - 10.1016/0735-1097(89)90519-6
DO - 10.1016/0735-1097(89)90519-6
M3 - Article
C2 - 2464015
AN - SCOPUS:0024535071
VL - 13
SP - 406
EP - 412
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 2
ER -