Abstract
Background: Energy inefficiencies lead to Fontan procedure failures. Our purpose was to quantify energy inefficiencies of various Fontan procedures using flow analysis. Materials and methods: The study included 12 patients with Fontan operations; 7 with classic trans-atrial flow and five extra-cardiac Fontans. Flow analysis was used to determine the systolic and diastolic flow in the superior vena cava and inferior venous circulations (IVC, right atrium or conduit). Retrograde flow fractions were calculated. Inferior venous flow analysis was obtained in 12 patients and superior vena cava in 9 patients. Results: A seesaw pattern (augmented inferior venous flow during diastole and augmented superior vena cava flow in systole) was present in five of seven patients with trans-atrial Fontan procedures, but no patient with an extra-cardiac Fontan procedure. Significant retrograde flow occurred in the superior vena cava in three children with trans-atrial Fontan procedures (retrograde flow fractions of 15–22%). Inferior venous flow occurred predominantly during diastole in five of seven children with trans-atrial Fontan procedures. Retrograde flow occurred in all seven children with the retrograde flow fractions ranging from 9 to 37%(mean 25%). Extra-cardiac Fontan flow was characterized by continuous balanced flow during systole and diastole. The association of the seesaw pattern with trans-atrial Fontan procedures was statistically significant (p= 0.028). Conclusions: Classic trans-atrial Fontan procedures are characterized by energy inefficiency creating a seesaw flow pattern of forward and reverse flow. Extra-cardiac Fontan procedures are more energy efficient. Magnetic resonance imaging is useful in detecting flow inefficiencies in patients palliated by the Fontan procedure.
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References
Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.
Berggren H. The Fontan procedure:a bad operation? Scand Cardiovasc J 2002; 36: 69–70.
Ensley AE, Ramuzat A, Healy T,et al. Fluid mechanic assessment of the total cavopulmonary connection using magnetic resonance phase velocity mapping and digital particle image velocimetry. Ann Biomed Eng 2000; 28: 1172–1183.
de Laval MR, Kilner P, Gewillig M,et al. Total cavopul-monary connection:a logical alternative to atriopulmonary connection for complex Fontan operations.Experimental studies and early clinical experience. J Thorac Cardiovasc Surg 1988; 96: 682–695.
van Haesdonck JM, Mertens L, Sizaire R,et al. Comparison by computerized numeric modeling of energy losses in different Fontan connections. Circulation 1995; 92: S322–S326.
Rebergen SA, Ottenkamp J, Doornbos J,et al. Postoperative pulmonary flow dynamics after Fontan surgery: assessment with nuclear magnetic resonance velocity map-ping. J Am Coll Cardiol 1993; 21: 123–131.
Geggel RL. Update on the modified Fontan procedure. Curr Opin Cardiol 1997; 12: 51–63.
Marino BS. Outcomes after the Fontan procedure. Curr Opin Cardiol 2002; 14: 620–626.
Yetman AT, Drummond-Webb J, Fiser WP,et al. The ex-tracardiac Fontan procedure without cardiopulmonary by-pass:technique and intermediate-term results. Ann Thorac Surg 2002; 74: S1416–S1421.
Baslaim G, Hussain A, Kouatli A, Jamjoom A. Bovine valved xenograft conduits in the extracardiac Fontan pro-cedure. J Thorac Cardiovasc Surg 2003; 126: 586–588.
Haas GS, Hess H, Black M,et al. Extracardiac conduit Fontan procedure:early and intermediate results. Eur J Cardiothorac Surg 2000; 17: 648–654.
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Greenberg, S.B., Morrow, W.R., Imamura, M. et al. Magnetic Resonance Flow Analysis of Classic and Extracardiac Fontan Procedures: The Seesaw Sign. Int J Cardiovasc Imaging 20, 397–405 (2004). https://doi.org/10.1023/B:CAIM.0000041941.59010.4c
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DOI: https://doi.org/10.1023/B:CAIM.0000041941.59010.4c