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Is the “Perfect Fontan” operation routinely achievable in the modern era?*
- James K. Kirklin, Robert N. Brown, Ayesha S. Bryant, David C. Naftel, Edward V. Colvin, F. Bennett Pearce, Robb L. Romp, Walter H. Johnson, Jr, Yung R. Lau, William S. McMahon, Christopher J. Knott-Craig, Albert D. Pacifico
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- Journal:
- Cardiology in the Young / Volume 18 / Issue 3 / June 2008
- Published online by Cambridge University Press:
- 01 June 2008, pp. 328-336
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Objective
In 1990, Fontan, Kirklin, and colleagues published equations for survival after the so-called “Perfect Fontan” operation. After 1988, we evolved a protocol using an internal or external polytetraflouroethylene tube of 16 to 19 millimetres diameter placed from the inferior caval vein to either the right or left pulmonary artery along with a bidirectional cava-pulmonary connection. The objective of this study was to test the hypothesis that a “perfect” outcome is routinely achievable in the current era when using a standardized surgical procedure.
MethodsBetween 1 January, 1988, and 12 December, 2005, 112 patients underwent the Fontan procedure using an internal or external polytetraflouroethylene tube plus a bidirectional cava-pulmonary connection, the latter usually having been constructed as a previous procedure. This constituted 45% of our overall experience in constructing the Fontan circulation between 1988 and 1996, and 96% of the experience between 1996 and 2005. Among all surviving patients, the median follow-up was 7.3 years. We calculated the expected survival for an optimal candidate, given from the initial equations, and compared this to our entire experience in constructing the Fontan circulation.
ResultsAn internal tube was utilized in 61 patients, 97% of whom were operated prior to 1998, and an external tube in 51 patients, the latter accounting for 95% of all operations since 1999. At 1, 5, 10 and 15 years, survival of the entire cohort receiving polytetraflouroethylene tubes is superimposable on the curve calculated for a “perfect” outcome. Freedom from replacement or revision of the tube was 97% at 10 years.
ConclusionUsing a standardized operative procedure, combining a bidirectional cavopulmonary connection with a polytetraflouroethylene tube placed from the inferior caval vein to the pulmonary arteries for nearly all patients with functionally univentricular hearts, early and late survival within the “perfect” outcome as predicted by the initial equations of Fontan and Kirklin is routinely achievable in the current era. The need for late revision or replacement of the tube is rare.
Africa and the Biblical Period
- Robert A. Bennett, Jr
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- Journal:
- Harvard Theological Review / Volume 64 / Issue 4 / October 1971
- Published online by Cambridge University Press:
- 10 June 2011, pp. 483-500
- Print publication:
- October 1971
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The Holy Bible represents the literary deposit of the Hebrew people's faith in God's intervention within human history to liberate them and mankind from physical and spiritual bondage. Even though this divine revelation was given to a specific people at a specific time within history, its power and hoped-for fulfillment continues to be the basis of religious faith for Jew and Christian alike. Consequently, the most potent aspect of the Scriptures for the Black community in Africa and the Americas is its present meaning and revelation for us in our struggle today for physical and spiritual liberation. The particularity of the mode of biblical revelation — the witness of a specific people at a particular point in history — suggests that the medium is also the message, namely, that God's word is intended for identifiable situations rather than to be taken as amorphous, generalized truth having little to do with the specifics of the human condition. The American Association of Theological Schools' journal, Theology Today, Vol. 6, No. 3 (Spring, 1970) plus Supplement, turns its attention to this question of the divine revelation and a specific human situation under the title of “The Black Religious Experience and Theological Education.” James Cone, A Black Theology of Liberation (New York: Lippincott, 1970), offers a forceful argument for the biblical basis of the present black social and spiritual revolution. See also, J. Deotis Roberts, Liberation and Reconciliation: A Black Theology (Philadelphia: Westminster Press, 1971). However, while the hermeneutical task of proclaiming God's word to contemporary ears is of the greater importance — it is ontologically prior, there is also the necessity — chronologically prior — of adequately describing the Biblical word on the basis of its own setting. Dean Krister Stendahl has given classic statement to the fundamental role of the descriptive process, of what the Bible “meant,” before we take up what it “means,” in his article on “Contemporary Biblical Theology,” Interpreter's Dictionary of the Bible, Vol. I (New York: Abingdon, 1962). Black consciousness is ultimately informed and inspired by the biblical message, but it also has some questions which it would address to Holy Scripture. Among these questions are those concerning the African presence in the Bible and the role of Africa in the period of biblical revelation.