Extracardiac Fontan operation after late bidirectional Glenn shunt.
The outcomes of 33 consecutive extracardiac Fontan operations performed between 1999 and 2008 in patients who mostly had initial Glenn shunts beyond infancy were reviewed. Preoperatively, the median oxygen saturation was 76.2% and mean pulmonary artery pressure was 10.5 mm Hg. The median age was 4.1 years at Glenn shunt procedure and 10 years at Fontan operation. The duration of chest tube drainage was longer in these patients than in series where Glenn shunts were created at a younger age. All patients received warfarin for 1 year, then warfarin and/or aspirin. At follow-up (median, 14 months), there was no significant ventricular dysfunction. Median oxygen saturation at the last follow-up was 92%. All patients in sinus rhythm preoperatively continued in this status. There was no Fontan failure or mortality. All patients were in New York Heart Association class I or II, although objective cardiopulmonary exercise evaluation in 8 patients showed impaired exercise tolerance. Despite a trend towards prolonged pleural effusion, there was no adverse outcome in the short or intermediate term. Long-term follow-up is required to see whether delayed creation of a Glenn shunt is associated with late disadvantages.
The Madras Medical Mission, Dr J Jayalalitha Nagar, Mogappair, Chennai, Tamil Nadu, India.
Madhusudan
M
Ganigara
Atul
A
Prabhu
Roy
R
Varghese
Sreeja
S
Pavithran
John
J
Valliatu
Raghavan Suresh Kumar
RS
Nair
D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001794:Blood Pressure; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000295:instrumentation; D004359:Drug Therapy, Combination; D017079:Exercise Tolerance; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects; D018610:Heart Bypass, Right / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007194:India; D008297:Male; D010100:Oxygen / Q000097:blood; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010996:Pleural Effusion / Q000209:etiology / Q000628:therapy; D011651:Pulmonary Artery / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin; D010100:Oxygen