Summary
The cardiac rhythm before and after the modified Fontan procedure was reviewed in 24 patients. Transient atrial dysrhythmias were common in the immediate postoperative period. Late postoperative premature atrial contractions were detected by ambulatory monitoring in 20 of 23 patients; eight (34.8%) had supraventricular tachycardia. Late ventricular dysrhythmia was detected in 18 of 23 patients: ten had low-grade ventricular dysrhythmias and eight (34.8%) had multiform premature ventricular contractions. Five of the latter had couplets and one of these five plus another had ventricular tachycardia. Seven patients with supraventricular tachycardia and five patients with ventricular dysrhythmia required antiarrhythmic medication. Asymptomatic bradycardia was detected in five patients (21.7%). One patient had intermittent second-degree atrioventricular block. No specific risk factors predicted dysrhythmias. Thus, cardiac dysrhythmias were common in patients after the modified Fontan procedure, but were well tolerated in most patients. No sudden deaths or syncopal episodes have occurred during a mean follow-up of 5 years. One patient's death was related to severe left ventricular dysfunction. Permanent pacing has not been required in any patient.
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References
Alboliras ET, Porter C-BJ, Danielson GE, et al. (1985) Results of the modified Fontan operation for congenital heart lesions in patients without preoperative sinus rhythm.J Am Coll Cardiol 6:228–233
Behrendt DM, Rosenthal A (1980) Cardiovascular status after repair by Fontan procedure.Ann Thorac Surg 29:322–330
Choussat A, Fontan F, Besse P, Vallot F, Chauve A, Bricaud H (1978) Selection criteria for Fontan's procedure. In: Anderson RH, Shinebourne EA (eds)Pediatric Cardiology 1977. Churchill-Livingstone, Edinburgh, pp 559–566
Cumming GR, Everatt D, Hastman L (1978) Bruce treadmill test in children: normal values in a clinic population.Am J Cardiol 41:69–75
De Brux J-L, Zannini L, Binet J-P, et al. (1983) Tricuspid atresia: results of treatment in 115 children.J Thorac Cardiovasc Surg 85:440–446
Fontan F, Baudet E (1971) Surgical repair of tricuspid atresia.Thorax 26:240–248
Lee C-N, Schaff HV, Danielson GK, Puga FJ, Driscoll DJ (1986) Comparison of atriopulmonary versus atrioventricular connections for modified Fontan/Krentzer repair of tricuspid valve atresia.J Thorac Cardiovasc Surg 92:1038–1048
Mair DD, Rice MJ, Hagler DJ, Puga FJ, McGoon DC, Danielson GK (1985) Outcome of the Fontan procedure in patients with tricuspid atresia.Circulation [Suppl 2]72:88–92
Porter CJ, Battiste CE, Humes RA, Offord KP, Puga FJ, Schaff HV, Danielson GK (1986) Risk factors for supraventricular tachycardias after Fontan procedure for tricuspid atresia [abstr].Am Heart J 112:645
Rice MJ, Mair DD, Puga FJ, Danielson GK, Driscoll DJ, Edwards WD (1982) Clinical hemodynamic and functional assessment of 180 patients undergoing the modified Fontan procedure [abstr].Circulation [Suppl 2]66:II-30
Schachar GB, Fuhrman BP, Wang Y, Lucas RV, Lock JE (1982) Rest and exercise hemodynamics after the Fontan procedure.Circulation 65:1043–1048
Sharratt GP, Johnson AM, Monro JL (1979) Persistence and effects of sinus rhythm after Fontan procedure for tricuspid atresia.Br Heart J 42:74–80
Southall DP, Johnston F, Shinebourne EA, Johnston PGB (1981) Twenty-four hour electrocardiographic study of heart rate and rhythm patterns in population of healthy children.Br Heart J 45:281–291
Stanton RE, Lurci PR, Lindesmith GG, Meyer BW (1981) The Fontan procedure for tricuspid atresia.Circulation [Suppl 2]64:140–146
Taliercio CP, Vlietstra RE, McGoon MD, Porter C-B, Osborn MJ, Danielson GK (1985) Permanent cardiac pacing after the Fontan procedure.J Thorac Cardiovasc Surg 90:414–419
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Chen, Sc., Nouri, S. & Pennington, D.G. Dysrhythmias after the modified Fontan procedure. Pediatr Cardiol 9, 215–219 (1988). https://doi.org/10.1007/BF02078411
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DOI: https://doi.org/10.1007/BF02078411