Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-26T04:04:48.842Z Has data issue: false hasContentIssue false
  • English
  • Français

Morphology of hearts undergoing Fontan repair

Published online by Cambridge University Press:  19 August 2008

Vivek Murari ,
Rajesh Sharma ,
Balram Airan ,
Anil Bhan ,
Shiv K. Choudhary ,
Anita Saxena ,
Shyam S. Kothari ,
Subhash C. B. Reddy  and
Panangipalli Venugopal
Vivek Murari
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Rajesh Sharma*
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Balram Airan
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Anil Bhan
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Shiv K. Choudhary
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Anita Saxena
Affiliation:
Department of CardiologyCardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Shyam S. Kothari
Affiliation:
Department of CardiologyCardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Subhash C. B. Reddy
Affiliation:
Department of CardiologyCardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Panangipalli Venugopal
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
*
Dr Rajesh Sharma, Associate Professor, Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi 110 029, India Tel 91-11 - 661123, 6864851 - Extn # 4835, Fax 91-11 - 6862663
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Notwithstanding the controversies evoked by the term “single ventricle”, most patients with this condition would undergo the Fontan procedure. In addition, there is a large group of patients in whom a biventricular repair would be abandoned in favour of a univentricular one because of the presence of unfavourable morphologic features. There is a need for a uniformly acceptable system of nomenclature that would permit precise description and classification of hearts with complex malformations to facilitate reporting and help in understanding the reasons for choosing a univentricular repair.

Methods

Echocardiographic, angiographic and operative records of 240 patients undergoing the Fontan procedure were analysed.

Results

Out of the 104 patients with univentricular atrioventricular connections, 2 ventricles were discernible in all but 3 patients. A Fontan repair was performed in 136 patients with biventricular atrioventricular connections because of the presence of a hypoplastic ventricle in 52 patients and a non-committed ventricular septal defect in the remaining 84.

Conclusions

The Fontan operation is probably the only definitive treatment option for patients with univentricular atrioventricular connections. The decision to perform a univentricular repair in preference to a biventricular one in hearts with biventricular atrioventricular connections is based on the presence of a hypoplastic ventricle or a non-reroutable ventricular septal defect. This decision is subjective. In hearts with discordant atrioventricular connections and pulmonary stenosis, we prefer the Fontan operation to the classical repair.

Keywords

Fontan procedureheart defects, congenitalheart bypass, right
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 2 , April 1998 , pp. 165 - 171
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Driscoll, DJ, Offord, KP, Feldt, RH, Schaff, HV, Puga, FJ, Danielson, GK. Five to fifteen year followup after the Fontan operation. Circulation 1992; 85: 469–496.CrossRefGoogle Scholar
2.Stein, DG, Laks, H, Drinkwater, DC, Permut, LC, Louie, HW, Pearl, JM, George, BL, Williams, RG. Results of total cavopulmonary connection in the treatment of patients with a functional single ventricle. J Thorac Cardiovasc Surg 1991; 102: 280–286.CrossRefGoogle ScholarPubMed
3.Fontan, F, Kirklin, JW, Fernandez, G, Costa, F, Naftel, DC, Tritto, F, Blacksrone, EH. Outcome after a perfect Fontan operation. Circulation 1990; 81: 1520–1536.Google Scholar
4.Rao, PS. Terminology: Is tricuspid atresia the correct term to use? In: Rao, PS (ed). Tricuspid atresia 2nd ed. Futura Publishing Company, Inc, Mount Kisco, New York, 1992, pp3–15.Google Scholar
5.Anderson, RH, Becker, AE, Tynan, M, Macartney, FJ, Rigby, ML, Wilkinson, JL. The univentricular atrioventricular connection: getting to the root of a thorny problem. Am J Cardiol 1984; 54: 822–828.Google Scholar
6.Fontana, GP, Permut, LC, Laks, H. Surgical management of complex functional single ventricle. In: Baue, AE, Geha, AS, Hammond, GL, Laks, H, Naunheim, KS (ed). Glenn's thoracic and cardiovascular surgery 6th ed. Appleton and Lange, Stamford, Connecticut, 1995, pp 193–1201.Google Scholar
7.Barlow, A, Pawade, A, Wilkinson, JL, Anderson, RH. Cardiac anatomy in patients undergoing the Fontan procedure. Ann Thorac Surg 1995; 60: 1324–1330.CrossRefGoogle ScholarPubMed
8.Anderson, RH, Macartney, FJ, Shinebourne, EA, Tynan, M. Terminology. In: Anderson, RH, Macartney, FJ, Shinebourne, EA, Tynan, M (ed). Paediatric Cardiology. Churchill Livingstone, London & Edinburgh, 1987, pp65–82Google Scholar
9.Deanfield, JE, Tomasini, G, Anderson, RH, Macartney, FJ. Tricuspid atresia: analysis of coronary artery distribution and ventricular morphology. Br Heart J 1982; 48: 485–492.CrossRefGoogle ScholarPubMed
10.Anderson, RH, Rigby, ML. The morphologic heterogeneity of tricuspid atresia editorial note. Int J Cardiol 1987; 16: 67–73.CrossRefGoogle Scholar
11.Kurosawa, H, Imai, Y, Fukuchi, S, Sawatari, K, Koh, Y, Nakazawa, M, Takao, A. Septation and Fontan repair of uni ventricular atrioventricular connection. J Thorac Cardiovasc Surg 1990; 99: 314–319.CrossRefGoogle Scholar
12.Prasad, K, Bairam, A, Iyer, KS, Murthy, KS, Shrivastava, S, Rajani, M, Ran, TM. Surgical treatment of major intracardiac lesions associated with discordant atrioventricular connexion. Int J Cardiol 1990; 26: 191–200.CrossRefGoogle ScholarPubMed
13.Prasanna, KGJ, Sharma, R, Iyer, KS, Airan, B, Bhan, A, Kothari, SS, Saxena, A, Rao, TM, Venugopal, P. Single versus biventricular repair for discordant hearts. Asian Cardiovasc Thorac Ann 1996; 4: 161–163.CrossRefGoogle Scholar
14.Termignon, JL, Leca, F, Vouhe, PR, Vernant, F, Bical, OM, Lecompte, Y, Neveux, JY. Classic repair of congenitally corrected transposition and ventricular septal defect. Ann Thorac Surg 1996; 62: 199–206.Google Scholar
15.Van Son, JAM, Danielson, GK, Huhta, JC, Warnes, CH, Edwards, WD, Schaff, HV, Puga, FG, llstrup, DM. Late results of systemic atrioventricular valve replacement in corrected transposition. J Thorac Cardiovasc Surg 1995; 109: 642–653.Google Scholar
16.Kirklin, JW, Barratt-Boyes, BG (ed). Cardiac surgery 2nd ed. Churchill Livingstone, New York, 1993, pp 1511–1533.Google Scholar
17.Ilbawi, MN, Smith, PC. Congenitally corrected transposition of the great arteries. In: Baue, AE, Geha, AS, Hammond, GL, Laks, H, Naunheim, KS, editors. Glenn's thoracic and cardiovascular surgery 6th ed. Appleton and Lange, Stamford, Connecticut, 1995, pp 1409–1416.Google Scholar
18.Puga, FJ. The Rastelli procedure for transposition of the great vessels, pulmonary stenosis and ventricular septal defect. In Baue, AE, Geha, AS, Hammond, GL, Laks, H, Naunheim, KS (ed). Glenn's thoracic and cardiovascular surgery 6th ed. Stamford, Connecticut: Appleton and Lange 1995, pp 1383–1392.Google Scholar
19.Villagra, F, Quero-Jimenez, M, Maitre-Azcarate, MJ, Gutierrez, J, Brito, JM. Transposition of the great arteries with ventricular septal defects. Surgical considerations concerning the Rastelli operation. J Thorac Cardiovasc Surg 1984; 88: 1004–1011.Google Scholar
20.Niinami, H, Imai, Y, Sawatari, K, Hoshino, S, Ishihara, K, Aoki, M. Surgical management of tricuspid malinsertion in the Rastelli operation: conal flap method. Ann Thorac Surg 1995; 59: 1476–1480.CrossRefGoogle ScholarPubMed
21.Stellin, G, Ho, SY, Anderson, RH, Zuberbuhler, JR, Siewers, RD. The surgical anatomy of double-outlet right ventricle with concordant atrioventricular connection and noncommitted ventricular septal defect. J Thorac Cardiovasc Surg 1991; 102: 849–855.CrossRefGoogle ScholarPubMed
22.Seraff, A, Nakamura, T, Lacour-Gayet, F, Piot, D, Bruniaux, J, Touchot, A, Sousa-Uva, M, Houyel, L, Planche, C. Surgical approaches for double-outlet ventricle or transposition of the great arteries associated with straddling atrioventricular valves. J Thorac Cardiovasc Surg 1996; 111: 527–535.CrossRefGoogle Scholar
23.Aoki, M, Forbess, JM, Jonas, RA, Mayer, JE, Castaneda, AR. Result of biventricular repair for double-outlet right ventricle. J Thorac Cardiovasc Surg 1994; 107: 338–350CrossRefGoogle ScholarPubMed