Early and intermediate results of the Fontan procedure at moderately high altitude.
At higher elevations, alveolar hypoxia increases pulmonary vascular resistance and may limit the cardiac output of individuals without a subpulmonary ventricle. Thus, we reviewed the outcome of definitive palliation for tricuspid atresia and other forms of single ventricle in 60 consecutive Fontan patients living at a mean elevation of 1,370 m (range, 910 to 2,130 m). There were four early deaths (6.7%; 70% confidence limits, 4.1% to 10.7%) and six late deaths. Kaplan-Meier actuarial survival (+/- standard error) is 79.6% +/- 8.2% at 5 years. Survival was significantly decreased in patients with a preoperative mean pulmonary arterial pressure greater than or equal to 15 mm Hg unless the Fontan procedure was performed with a residual fenestration. Exercise tolerance was significantly worse at higher elevations in a subgroup of patients who have traveled to altitudes of 1,680 to 3,350 m. We conclude that the early and intermediate results of the Fontan procedure at moderately high altitude are similar to results reported at sea level. However, exercise tolerance may be impaired at higher elevations in many patients.
Day
R W
RW
Division of Pediatric Cardiology, Primary Children's Medical Center, Salt Lake City, Utah 84113.
Orsmond
G S
GS
Sturtevant
J E
JE
Hawkins
J A
JA
Doty
D B
DB
McGough
E C
EC
D000293:Adolescent; D000531:Altitude; D001794:Blood Pressure / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D011651:Pulmonary Artery / Q000503:physiopathology; D016019:Survival Analysis; D014261:Tricuspid Valve / Q000002:abnormalities / Q000601:surgery