The fenestrated Fontan procedure.
In 90 patients with characteristics placing them at increased risk for a Fontan operation, a fenestration was created in the atrial baffle at the time of the Fontan repair. The rational was to allow a right to left shunt which would maintain cardiac output and limit right atrial pressure in the presence of conditions which limit pulmonary blood flow. Early mortality was 4/90 (4%), with an additional two patients having the Fontan repair taken down to a bidirectional cavopulmonary anastomosis. Postoperative right atrial pressures were low (average 13 mm Hg), as was the incidence of prolonged pleural effusions (13%). At short-term (average 13 months) follow-up, 77% of patients have had closure of the fenestration, and 92% are in New York Heart Association Class I. We conclude that baffle fenestration with subsequent transcatheter closure results in decreased mortality and morbidity among high risk patients undergoing a Fontan repair, and that the high functional level at short-term follow-up justifies continued aggressive management of such patients.
Bridges
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Department of Cardiology, Children's Hospital, Boston.
Castaneda
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AR
D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization; D002303:Cardiac Output, Low / Q000175:diagnosis / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006346:Heart Septum / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D010100:Oxygen / Q000097:blood; D010166:Palliative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology*; D012086:Reoperation
D010100:Oxygen