Skip to main content

Advertisement

SpringerLink
Log in

Chirurgische Behandlung univentrikulärer Herzen

Geht’s noch?

Surgical management of univentricular hearts

Still working?

  • 30 Jahre ZfHTG
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

In der Kommentierung unserer Arbeit aus 1992 über die chirurgische Behandlung univentrikulärer Herzen zeigen wir die vorhandenen Möglichkeiten der 1980er-Jahre und die Entwicklungen auf, die sich daraus ergeben haben. Während sich zwischenzeitlich der Fortschritt auf dem chirurgisch technischen Gebiet nivelliert hat, stehen heute die Langzeitprobleme der Fontan-Zirkulation und Überlegungen zu ihrer Vermeidung im Vordergrund.

Abstract

Commenting on our own 1992 publication on surgical management of univentricular hearts, we describe the surgical options of the 1980s and the resulting further development to current levels. Nowadays, technical aspects of surgery and quality of perioperative management have reached a plateau; however, management of the long-term problems of Fontan circulation and efforts to avoid them are of major interest.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8

Literatur

  1. Akintürk H, Michel-Behnke I, Valeske K, Mueller M, Thul J, Bauer J, Hagel K‑J, Kreuder J, Vogt P, Schranz D (2002) Stenting of the arterial duct and banding of the pulmonary arteries: basis for combined Norwood stage I and II repair in hypoplastic left heart. Circulation 105:1099–1103

    Article  Google Scholar 

  2. Anssari SK, Warnes CA, Kamath PS (2013) Hepatocellular carcinoma after the Fontan procedure. N Engl J Med 368:1756–1757

    Article  Google Scholar 

  3. Bjoerk VO, Olin CL, Bjark BB, Thoren CA (1979) Right atrial – right ventricular anastomosis for correction of tricuspid atresia. J Thorac Cardiovasc Surg 77:452–458

    Google Scholar 

  4. Bridges ND, Lock JE, Castaneda AR (1990) Baffle fenestration with subsequent transcatheter closure: Modification of the Fontan operation for patients at increased risk. Circulation 82:1681–1689

    Article  CAS  PubMed  Google Scholar 

  5. Bridges ND, Jonas RA, Mayer JE, Flanagan MF, Keane JF, Castaneda AR (1990) Bidirectional cavopulmonary anastomosis as interim palliation for high-risk Fontan candidates: Early results. Circulation 82(Suppl IV):IV170–IV176

    CAS  PubMed  Google Scholar 

  6. de Leval MR, Kilner P, Gewillig M, Bull C (1988) Total cavopulmonary connections: a logical alternative to atriopulmonary connections for complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg 96:682–695

    CAS  PubMed  Google Scholar 

  7. Elder RW, McCabe NM, Veledar E, Kogon BE, Jokhadar M, Rodriguez FH 3rd, McConnell ME, Book WM (2014) Risk factors for major adverse events late after Fontan palliation. Cong Heart Dis 10:159–168

    Article  Google Scholar 

  8. Fontan F, Baudet E (1971) Surgical repair of tricuspid atresia. Thorax 26:240–248

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  10. Gerelli S, Boulitrop C, Van Steenberghe M, Maldonado D, Bojan M, Raisky O, Sidi D, Vouhé PR (2012) Bidirectional cavopulmonary shunt with additional pulmonary blood flow: a failed or successful strategy? Eur J Cardio-Thoracic Surg 42(3):513–519

    Article  Google Scholar 

  11. Glenn WWL (1958) Circulatory Bypass of the right side of the heart. N Engl J Med 259:117–120

    Article  CAS  PubMed  Google Scholar 

  12. Greenway SC, Crossland DS, Hudson M, Martin SR, Prieur T, Hasan A, Kirk R (2016) Fontan-associated liver disease: Implications for heart transplantation. J Heart Lung Transplant 35:26–33

    Article  PubMed  Google Scholar 

  13. Hausdorf G, Schneider M, Konertz W (1996) Surgical preconditioning and completion of total cavopulmonary connection by interventional cardiac catheterization: a new concept. Heart 75:403–409

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Heck HA Jr, Doty DB (1981) Assisted circulation by phasic lower body compression. Circulation 64(Suppl 2):118–122

    Google Scholar 

  15. Hopkins RA, Armstrong BE, Serwer GA, Peterson RJ, Oldham HN (1985) Physiological rationale for a bidirectional cavopulmonary shunt. A versatile complement to the Fontan principle. J Thorac Cardiovasc Surg 90:391–398

    CAS  PubMed  Google Scholar 

  16. Jacobs ML (2005) The Fontan operation, thromboembolism, and anticoagulation: A reappraisal of the single bullet theory. J Thorac Cardiovasc Surg 129:491–495

    Article  PubMed  Google Scholar 

  17. Jonas RA, Castaneda AR (1988) Modified Fontan procedure: atrial baffle and systemic venous to pulmonary artery anastomotic techniques. J Cardiac Surg 3:91–96

    Article  CAS  Google Scholar 

  18. Kaulitz R, Ziemer G, Luhmer I, Paul T, Kallfelz HC (1995) Total cavopulmonary anastomosis in patients less than three years of age. Ann Thorac Surg 60:563–567

    Article  Google Scholar 

  19. Kaulitz R, Ziemer G, Luhmer I, Kallfelz HC (1996) Modified Fontan Operation in functional univentricular hearts – preoperative risk factors and intermediate results. J Thorac Cardiovasc Surg 112:658–664

    Article  CAS  PubMed  Google Scholar 

  20. Kaulitz R, Ziemer G, Rauch R, Girisch M, Bertram H, Wessel A, Hofbeck M (2005) Prophylaxis of thromboembolic complications after the Fontan operation (total cavopulmonary anastomosis). J Thorac Cardiovasc Surg 129:569–575

    Article  PubMed  Google Scholar 

  21. Lange R, Hoerer J (2010) Funktionell singulärer Ventrikel und Fontan Operation. In: Ziemer G, Haverich A (Hrsg) Herzchirurgie, 3. Aufl. Springer, Berlin Heidelberg New York, S 331–361

    Chapter  Google Scholar 

  22. Marceletti C, Corno A, Giannico S, Marino B (1990) Inferior vena cava-Pulmonary artery extracardiac conduit. A new form of right heart bypass. J Thorac Cardiovasc Surg 100:228–232

    Google Scholar 

  23. Meshalkin EN (1956) Anastomosis of upper vena cava with pulmonary artery in patients with congenital heart disease. ESP Khir 1:3–12

    Google Scholar 

  24. Norwood WI, Kirklin JK, Sanders SP (1980) Hypoplastic left heart syndrome: experience with palliative surgery. Am J Cardiol 45:87–91

    Article  CAS  PubMed  Google Scholar 

  25. Mori M, Jokhadar M, Shioda K, Sahu A, Elder R, Hebson C, McCabe N, Kogon B, Bock W (2014) Reduced hepatic venous flow is a marker of adverse outcomes in patients with Fontan circulation. JACC 63:A566 (Abstr.)

    Article  Google Scholar 

  26. Norwood WI, Lang P, Hansen DD (1983) Physiologic repair of aortic atresia-hypoplastic left heart syndrome. N Engl J Med 308:23–26

    Article  CAS  PubMed  Google Scholar 

  27. Reddy VM, McElhinney DB, Moore P, Petrossian E, Hanley FL (1996) Pulmonary artery growth after bidirectional cavopulmonary shunt: is there a cause of concern? J Thorac Cardiovasc Surg 112:1180–1192

    Article  CAS  PubMed  Google Scholar 

  28. Rodefeld MD, Coats B, Fisher T, Giridharan GA, Chen J, Brown JW, Frankel SH (2010) Cavopulmonary assist for the univentricular Fontan circulation: von Karman viscous impeller pump. J Thorac Cardiovasc Surg 140:529–536

    Article  PubMed  PubMed Central  Google Scholar 

  29. Rodefeld MD, Frankel SH, Giridharan GA (2011) Cavopulmonary assist: (Em)powering the Univentricular Fontan circulation. Semin Thorac Cardiovasc Surg Pediatr Cardsurg Ann 14:45–54

    Article  Google Scholar 

  30. Rychick J (2010) Forty years of the Fontan operation: A failed strategy. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 13:96–100

    Article  Google Scholar 

  31. Rychik J, Veldtman G, Rand E, Russo P, Rome JJ, Krok K, Goldberg DJ, Cahill AM, Wells RG (2012) The precarious state of the liver after a Fontan operation: Summary of a multidisciplinary symposium. Pediatr Cardiol 33:1001–1012

    Article  PubMed  PubMed Central  Google Scholar 

  32. Trusler GA, Williams WG (1980) Long-term results of shunt procedures for tricuspid atresia. Ann Thorac Surg 29:312–316

    Article  CAS  PubMed  Google Scholar 

  33. Wilder T, McCrindle B, Hickey E, Ziemer G, Tchervenkov C, Jacobs M, Gruber P, Blackstone E, Williams W, Decampli W, Calderone C, Pizarro C (2016) Is a hybrid strategy a lower-risk alternative to stage-1 Norwood operation? 2014 American Heart Meeting Scientific Sessions, Chicago, Illinois, November 15–19, 2014. (In print)

    Google Scholar 

  34. Wilder TJ, Ziemer G, Hickey EJ, Gruber PJ, Karamlou T, Kirshbom PM, Blackstone EH, McCrindle BW (2015) Surgical management of competing pulmonary blood flow affects survival before Fontan/Kreutzer completion in patients with tricuspid atresia type I. J Thorac Cardiovasc Surg 150(5):1222–1230

    Article  PubMed  Google Scholar 

  35. Wu FM, Ukomadu C, Odze RD, Valente AM, Mayer JE, Earing MG (2011) Liver disease in the patient with Fontan circulation. Congenit Heart Dis 6:190–120

    Article  PubMed  Google Scholar 

  36. Ziemer G, Castaneda AR (1991) Univentrikuläres Herz und Hypoplasien der rechten Kammer. In: Borst HG, Klinner W, Oelert H (Hrsg) Kirschnersche allgemeine und spezielle Operationslehre, 2. Aufl. Springer, Berlin, Heidelberg, S 83–104 (Band VI; Teil 2, Herzchirurgie)

    Google Scholar 

  37. Ziemer G, Heinemann M (1999) Preparatory surgical stent placement facilitating extracardiac vascular connections. Ann Thorac Surg 68:1431–1432

    Article  CAS  PubMed  Google Scholar 

  38. Ziemer G, Heinemann M, Karck M, Demertzis S, Luhmer I (1992) Die chirurgische Behandlung univentrikulärer Kreislaufsysteme. Z Herz Thorax Gefäßchir 6:243–245

    Google Scholar 

  39. Ziemer G, Kaulitz R (2012) 2011 Neues in der Kinderherzchirurgie. In: Messmer K, Jaehne J, Koenigsrainer A, Suedkamp NP, Schroeder W (Hrsg) Was gibt es Neues in der Chirurgie? Jahresband 2011. ecomed Medizin, Huethig Jehle Rehm, Heidelberg München, S 273–288

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. of Surgery, Div. Cardiac and Thoracic Surgery, University of Chicago Medicine (U of C), 5841 S. Maryland Avenue MC 5040 E500, 60637, Chicago, IL, USA

    G. Ziemer

  2. Ehemals Kinderklinik der Medizinischen Hochschule Hannover (MHH), Hannover, Deutschland

    I. Luhmer

  3. Kinderklinik, Universitätsklinkum Tübingen (UKT), Eberhard Karls Universität, Tübingen, Deutschland

    R. Kaulitz

Authors
  1. G. Ziemer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Luhmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Kaulitz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Ziemer.

Ethics declarations

Interessenkonflikt

G. Ziemer, I. Luhmer und R. Kaulitz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Caption Electronic Supplementary Material

398_2016_70_MOESM1_ESM.pdf

Beitrag: Ziemer G, Heinemann M, Karck M, Demertzis S, Luhmer I (1992) Die chirurgische Behandlung univentrikulärer Kreislaufsysteme. Z Herz Thorax Gefasschir 6: 243–245

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ziemer, G., Luhmer, I. & Kaulitz, R. Chirurgische Behandlung univentrikulärer Herzen. Z Herz- Thorax- Gefäßchir 30, 204–212 (2016). https://doi.org/10.1007/s00398-016-0070-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00398-016-0070-9

Schlüsselwörter

Keywords

Search

Navigation