Comparison of somatic development and status of conduit after extracardiac Fontan operation in young and older children.
OBJECTIVE
We set out to examine whether the extracardiac Fontan operation (ECFO) in young children is beneficial for the early postoperative course and whether it has a negative impact on the mid-term hemodynamics and growth of the children due to absent growth potential of the prosthetic conduit. Therefore we compared our medium-term experience with ECFO in children under 4 years of age to that in older children regarding the incidence of postoperative complications, somatomotoric development and conduit status.


RESULTS
Between 11/95 and 12/02 ECFO was performed in 30 children under 4 years of age and 21 older children aged 4-13 years. There were no deaths in children under 4 years of age and two older children died. No prolonged support (>72 h) of suprarenin was required in small children compared to 4 older children. In twenty-seven children, who underwent postoperative heart catheterization no pulmonary artery or systemic vein distortion occurred. One re-operation and one transcatheter intervention were performed because of the partial conduit stenosis. During the median follow-up of 4.8 years a manifestly accelerated postoperative weight gain was observed in children operated on under 4 years of age, compared to that in older children (up to the 50 vs. 10th percentile, P<0.05).


CONCLUSIONS
The ECFO could be performed in young children with low morbidity and mortality rates. In the majority of patients, implanted prosthetic grafts maintain stable form without the development of stenosis. Accelerated somatic development, especially in small children, is to be observed after completion of the Fontan circulation.
Ovroutski
Stanislav
S
Department of Congenital Heart Diseases, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Augustenburger Platz 1, 13533 Berlin, Germany. ovroutski@dhzb.de
Ewert
Peter
P
Alexi-Meskishvili
Vladimir
V
Stiller
Brigitte
B
Nürnberg
Jan-H
JH
Abdul-Khaliq
Hashim
H
Hetzer
Roland
R
Lange
Peter E
PE
D000293:Adolescent; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography / Q000379:methods; D018729:Fontan Procedure / Q000379:methods*; D006128:Growth; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D011651:Pulmonary Artery / Q000473:pathology; D012121:Respiration, Artificial / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D018785:Tricuspid Atresia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D015430:Weight Gain / Q000502:physiology