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A congenitally “poor” pulmonary artery is a major reason for exclusion from Fontan operation

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Summary

We reviewed the clinical records of 185 patients who were possible candidates for Fontan operation. We did this to clarify whether all patients with suitable anomalies ultimately underwent a Fontan operation. Of the 152 patients with decreased pulmonary blood flow, 38 (26%) did not fulfill the criteria for Fontan operation, and 17 of the 33 patients (52%) with increased pulmonary blood flow (P<0.01) were excluded as candidates. Of 48 non-candidate survivors, 19 had high pulmonary artery (PA) pressure or resistance and small PA (which we term “poor PA”), 17 had pulmonary hypertension, 6 had a markedly distorted PA, and 6 had severe ventricular dysfunction. A significant proportion of possible candidates with a suitable anomaly ultimately did not undergo a Fontan operation, because of “poor PA”, a congenital condition that precluded Fontan operation.

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References

  1. Russo P, Danielson GK, Puga FJ, McGoon Dc, Humes R (1988) Modified Fontan procedure for biventricular hearts with complex forms of double-outlet right ventricle. Circulation 78 [Suppl III]:III20-III25

    PubMed  CAS  Google Scholar 

  2. Mair DD, Hagler DJ, Julsrud PR, Puga FJ, Schaff HV, Danielson GK (1991) Early and late results of the modified Fontan procedure for double-inlet left ventricle: The Mayo experience. J Am Coll Cardiol 18:1727–1732

    Article  PubMed  CAS  Google Scholar 

  3. Humes RA, Feldt RH, Potre CJ, Julsrud PR, Puga FJ, Danielson GK (1988) The modified Fontan operation for asplenia and polysplenia syndromes. J Thorac Cardiovasc Surg 96:211–218

    Google Scholar 

  4. Mayer JE Jr, Helgason H, Jonas RA, Lang P, Vargas FJ, Cook N, Castaneda AR (1986) Expanding the limits for modified Fontan procedures. J Thorac Cardiovasc Surg 92:1021–1028

    PubMed  Google Scholar 

  5. Fontan F, Kirklin JW, Fernandez G, Costa F, Naftel DC, Tritto F, Blackstone EH (1990) Outcome after a “perfect” Fontan operation. Circulation 81:1520–1536

    PubMed  CAS  Google Scholar 

  6. Driscoll DJ, Offord KP, Feldt RH, Schaff HV, Puga FJ, Danielson GK (1992) Five-to fifteen-year follow-up after Fontan operation. Circulation 85:469–496

    PubMed  CAS  Google Scholar 

  7. Franklin RCG, Spiegelhalter DJ, Filho RIR, Macartney FJ, Anderson RH, Rigbey ML, Deanfield JE (1991) Double-inlet ventricle presenting in infancy. III. Outcome and potential for definitive repair. J Thorac Cardiovasc Surg 101:924–934

    PubMed  CAS  Google Scholar 

  8. Franklin RCG, Spiegelhalter DJ, Sullivan ID, Anderson RH, Thoele DG, Shinebourne EA, Deanfield JE (1993) Tricuspid atresia presenting in infancy. Survival and suitability for the Fontan operation. Circulation 87:427–439

    PubMed  CAS  Google Scholar 

  9. Zachary CH, Apostolopoulou SC, Jacobs ML, Fogel MA (1995) The one-lung Fontan—Hemodynamics and surgical outcome (abstract). Circulation 92:I-122

    Google Scholar 

  10. Park I, Nakazawa M, Imai Y, Sawatari K, Momma K (1994) Prediction of quality of life at long-term follow-up after Fontan operation by scoring risk factors. Jpn Circ J 58:646–652

    PubMed  CAS  Google Scholar 

  11. Nakata S, Imai Y, Takanashi Y, Kurosawa H, Tezuka K, Nakazawa M, Ando M, Takao A (1984) A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 88:610–619

    PubMed  CAS  Google Scholar 

  12. Yamamura H, Nakazawa M, Park I, Nakanishi T, Momma K, Sawatari K, Imai Y (1994) Asynchronous volume changes of the two ventricles after the Fontan operation in patients with a biventricular heart. Heart Vessels 9:307–314

    Article  PubMed  CAS  Google Scholar 

  13. Mietus-Snyder M, Lang P, Mayer JE, Jonas RA, Castaneda AR, Lock JE (1987) Childhood systemic-pulmonary shunts: Subsequent suitability for Fontan operation. Circulation 76 [Suppl III]:III39-III44

    PubMed  CAS  Google Scholar 

  14. Newfeld EA, Waldman D, Paul MH, Muster AJ, Code RB, Idriss FS, Riker W (1977) Pulmonary vascular disease after systemic-pulmonary arterial shunt operations. Am J Cardiol 39:715–720

    Article  PubMed  CAS  Google Scholar 

  15. Sluysmans T, Sanders SP, van der Velde M, Matitiau A, Parness IA, Spevak PJ, Mayer JE Jr, Colan SD (1992) Natural history and patterns of recovery of contractile function in single left ventricle after Fontan operation. Circulation 86:1753–1761

    PubMed  CAS  Google Scholar 

  16. Graham TP Jr (1991) Ventricular performance in congenital heart disease. Circulation 84:2259–2274

    PubMed  Google Scholar 

  17. Bartmus DA, Driscoll DJ, Offord KP, Humes RA, Mair DD, Schaff HV, Puga FJ, Danielson GK (1990) The modified Fontan operation for children less than 4 years old. J Am Coll Cardiol 15:429–435

    Article  PubMed  CAS  Google Scholar 

  18. Kirklin JK, Blackstone EH, Kirklin JW, Pacifico AD, Bargeron LM Jr (1986) The Fontan operation: Ventricular hypertrophy, age, and date of operation as risk factors. J Thorac Cardiovasc Surg 92:1049–1064

    PubMed  CAS  Google Scholar 

  19. Mair DD, Hagler DJ, Puga FJ, Schaff HV, Danielson GK (1990) Fontan operation in 176 patients with tricuspid atresia: Results and a proposed new index for patient selection. Circulation 82 [Suppl IV]:IV164-IV169

    PubMed  CAS  Google Scholar 

  20. Coles JG, Kielmanowicz S, Freedom RM, Benson LN, Moes F, Olley PM, Rabinovitch M, Rosenberg H, Sherret H, Rowe RD, McLaughlin PR, Trusler GA, Williams WG (1987) Surgical experience with the modified Fontan procedure. Circulation 76 (Suppl III):III61-III66

    PubMed  CAS  Google Scholar 

  21. Pearl JM, Laks H, Drinkwater DC, Capouya ER, George B, Williams RG (1992) Modified Fontan procedure in patients less than 4 years of age. Circulation 86 [Suppl II]:II100-II105

    PubMed  CAS  Google Scholar 

  22. Rosenberg HG, Williams WG, Trusler GA, Higa T, Rabinovitch M (1987) Structural composition of central pulmonary arteries. Growth potential after surgical shunts. J Thorac Cardiovasc Surg 94:498–503

    PubMed  CAS  Google Scholar 

  23. Wagenvoort CA, Nauta J, van der Schaar PJ, WEEda HWH, Wagenvoort H (1968) The pulmonary vasculature in complete transposition of the great vessels, judged from lung biopsies. Circulation 38:746–754

    PubMed  CAS  Google Scholar 

  24. Newfeld EA, Paul MH, Muster AJ, Idriss FS (1979) Pulmonary vascular disease in transposition of the great vessels with intact ventricular septum. Circulation 59:525–530

    PubMed  CAS  Google Scholar 

  25. Rabinovitch M, Castaneda AR, Reid L (1981) Lung biopsy with frozen section as a diagnostic aid in patients with congenital heart defects. Am J Cardiol 47:77–84

    Article  PubMed  CAS  Google Scholar 

  26. Yamaki S, Ajiki H, Haneda K, Takanashi Y, Ban T, Takahashi T (1994) Pulmonary arterial changes in patients dying after a modified Fontan procedure following pulmonary artery banding. Heart Vessels 9:263–268

    Article  PubMed  CAS  Google Scholar 

  27. Bridge ND, Jonas RA, Mayer JE, Flanagan MF, Keane JF, Castaneda AR (1990) Bidirectional cavopulmonary anastomosis as interim palliation for high risk Fontan candidates. Circulation 82 [Suppl IV]:170–176

    Google Scholar 

  28. de Leval M, Kilner P, Gewillig M, Bull C, McGoon DC (1988) Total cavopulmonary connection: A logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experiences. J Thorac Cardiovasc Surg 96:682–695

    PubMed  Google Scholar 

  29. Mendelsohn AM, Bove EL, Lupinetti FM, Crowley DC, Lloyd TR, Beekman RH III (1994) Central pulmonary artery growth patterns after the bidirectional Glenn procedure. J Thorac Cardiovasc Surg 107:1284–1290

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Cardiology, The Heart Institute of Japan, Tokyo Women's Medical College, 8-1 Kawada-cho, Shinjuku-ku, 162, Tokyo, Japan

    Makoto Nakazawa, Insam Park, Miho Yamada, Toshio Nakanishi & Kazuo Momma

  2. Department of Pediatric Cardiac Surgery, The Heart Institute of Japan, Tokyo Women's Medical College, 8-1 Kawada-cho, Shinjuku-ku, 162, Tokyo, Japan

    Shuichi Noshino, Yoshinori Takanashi & Yasuharu Imai

Authors
  1. Makoto Nakazawa
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  2. Insam Park
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  3. Miho Yamada
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  4. Toshio Nakanishi
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  5. Kazuo Momma
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  6. Shuichi Noshino
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  7. Yoshinori Takanashi
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  8. Yasuharu Imai
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Nakazawa, M., Park, I., Yamada, M. et al. A congenitally “poor” pulmonary artery is a major reason for exclusion from Fontan operation. Heart Vessels 11, 197–202 (1996). https://doi.org/10.1007/BF02559992

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  • DOI: https://doi.org/10.1007/BF02559992

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