CARDIOVASCULAR ENGINEERING Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs
	Volume 2, 1997, No 1

Improvement in Cardiovascular Parameters by the Staged Fontan Procedure in Infancy and Childhood

W.-R. Thies, T. Breymann, G. Kirchner, H. Meyer, R. Körfer

Abstract:
Already in infancy many children (ch.) with one underdeveloped ventricle are not ideal candidates for a complete Fontan type operation. By creating an upper bidirectional cavopulmonary anastomosis (CPA) within the first year of life, volume and sometimes pressure overload upon the dominant ventricle and upon the lungs should be reduced and in this way number and degree of risk factors should be diminished. Thus, despite the initial risk factors, conditions could be made to lead the majority of the ch. to complete separation of both circuits finally. Therefore, from 1991 to August 1995 an upper CPA was performed in 33 ch. with a median age of 9 months (3-29 m.). 82% of them failed the Choussat Fontan criteria in at least two parameters. Diagnoses: TCA=15, DILV=6, DORV with dominant left ventricle=2, HLHS=7, AVSD=3. Previous operations were pulmonary artery banding 11 cases, aortopulmonary anastomosis 6 cases, Norwood procedure 8 cases, repair of aortic coarctation or interrupted aortic arch 5 cases. Preoperative data: CTR: 0.63 ± 0.06; EDD of LV (N=26): 49 ± 17% above normal; EDP: 15 ± 3 mm Hg, mean PAP: 31 ± 11 mm Hg, PVRI art: 2.9 ± 1.4 Uxm2, SaO2: 82 ± 5%, weight: 27% <50.p. results: 3 cases died early. improved hemodynamics could be demonstrated in all survivors within the next five to ten months by the following parameters: ctr: 14%, edd: 27%, edp: 40%, pap: 56% to 13 ± 1.6 mm hg, sao2: 82 ± 4%, weight gain up to 18% < 50.p. after a mean period of 9 months the total cpa was completed in 23 ch. by the inferior cpa with 21 survivors. in 2 further ch. the bidirectional superior cpa was changed into an unidirectional cpa with an aortopulmonary shunt to the contralateral lung. the remaining 4 ch. are scheduled for the total cpa. conclusion: by an early upper cpa favourable changes of the myocardium as well as of the pulmonary arteries can be induced. many children, who are not ideal fontan candidates initially, will become acceptable for total cpa by the staged procedure. the total cpa is accomplished between the 14th and 20th month of life. this early relief of the volume and occasionally pressure overloaded ventricle should lead to a better long-term function of the ventricle.

Keywords:
bidirectional cavopulmonary anastomosis, single ventricle, staged Fontan operation, Glenn anastomosis, infancy

Address for Correspondence:

Reference:
(CVE. 1997; 2 (1): 55-60)

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