Thorac Cardiovasc Surg 2001; 49(2): 98-100
DOI: 10.1055/s-2001-11698
Original Cardiovascular
© Georg Thieme Verlag Stuttgart · New York

Long-term Problems after Cavopulmonary Anastomosis: Diagnosis and Management

J. Hess
  • Deutsches Herzzentrum München, Munich, Germany
Further Information

Publication History

Publication Date:
31 December 2001 (online)

After nearly three decades, the “Fontan-like” surgical approach for tricuspid atresia and other forms of functional univentricular heart disease have substantially improved life expectancy and functional status of these patients. However, over the years, complications such as persisting or reoccurring cyanosis, dysrhythmia, thromboembolism, protein-losing enteropathy and exercise intolerance have increasingly been reported. The management of these complications are related to their association with residual or recurrent structural lesions, which can be treated by catheter intervention or surgery, and to pathophysiological sequelae, directly associated to the specific characteristics of “Fontan-like” circulation. The recent modification might reduce this type of complication; however, hard data on this are not available yet.

References

  • 1 Fontan F, Mounicot F, Baudet E, Simonneau J, Gordo J, Gouffrant J. ”Correction” de l'atresie tricuspienne: rapport de deux cas “corriques” par l'utilisation d'une technique chirurqicale nouvelle.  Ann Chir Thorac Cardiovasc. 1971;  10 39-47
  • 2 Eygelaar A, Hess J, Karliczek G F, Rating W, Homan v. d. Heide J N. Experiences with the Fontan operation.  Thorac Cardiovasc Surgeon. 1982;  30 63-68
  • 3 Durongpisitkul K, Driscoll D J, Mahoney D W, Wollan P C, Mottram C D, Puga F J, Danielson G K. Cardiorespiratory response to exercise after modified Fontan operation.  JACC. 1997;  29 785-790
  • 4 Mair D D, Puga F J, Danielson G K. Late functional status of survivors of the Fontan procedure performed during the 1970s.  Circulation. 1992;  86 106-109
  • 5 Cromme-Dijkhuis A H, Hess J, Hahlen K, Henkens C M, Bink-Boelkens M T, Eygelaar A, Bos E. Specified sequelae after Fontan operation at mid- and long-term follow-up. Arrhythmia, liver dysfunction, and coagulation disorders.  J Thorac Cardiovasc Surg. 1993;  106 1126-1132
  • 6 de Leval M R, Kilner P, Gewillig M, Bull C. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations.  J Thorac Cardiovasc Surg. 1988;  96 682-695
  • 7 Okabe H, Nagata N, Kaneko Y, Kobayashi J, Kanemoto S, Takaoka T. Extracardiac cavopulmonary connection of Fontan procedure with autologous pedicled pericardium without cardiopulmonary bypass.  J Thorac Cardiovasc Surg. 1998;  116 1073-1075
  • 8 Petrossian E, Reddy V M, McElhinney D B, Akkersdijk G P, Moore P h, Parry A J, Thompson L D, Hanley F L. Early results of the extracardiac conduit Fontan operation.  J Thorac Cardiovasc Surg. 1999;  117 688-696
  • 9 Kouatli A A, Garcia J A, Zellers T M, Weinstein E M, Mahony L. Enalapril does not enhance exercise capacity in patients after Fontan procedure.  Circulation. 1997;  96 (5) 1507-1513
  • 10 Suhara H, Ohtake S, Fukushima N, Ichikawa H, Ueda H, Ueno T, Matsuda H. Damus-Kaye-Stansel procedure for left ventricular outflow tract obstruction late after modified Fontan operation in patients with double-inlet left ventricle: report of two cases.  J Thorac Cardiovasc Surg. 1999;  117 624-626
  • 11 Fontan F, Kirklin J, Fernandez G, Costa F, Naftel D, Tritto F, Blackstone E. Outcome after a perfect Fontan operation.  Circulation. 1990;  81 1520-1536
  • 12 Driscoll D J, Offord K P, Feldt R H, Schaff H V, Puga F J, Danielson G K. Five- to fifteen-year follow-up after Fontan operation.  Circulation. 1992;  85 469-496
  • 13 Jahangiri M, Ross D B, Redington A N. Thromboembolism after the Fontan procedure and its modifications.  Ann Thorac Surg. 1994;  58 1409-1414
  • 14 Cromme-Dijkhuis A C, Henkens C MA, Bijleveld C, Hillege H L, Bom V JJ, van der Meer J. Coagulation factor abnormalities as possible thrombotic risk factors after Fontan operations.  Lancet. 1990;  336 1087-1090
  • 15 Mertens L, Hagler D J, Sauer U, Somerville J, Gewillig M. Protein-losing enteropathy after the Fontan operation: an international multicenter study.  J Thorac Cardiovasc Surg. 1998;  115 1063-1073
  • 16 Hess J, Kruizinga K, Bijleveld C M, Hardjowijono R, Eygelaar A. Protein-losing enteropathy after Fontan operation.  J Thorac Cardiovasc Surg. 1984;  88 606-609
  • 17 Feldt R H, Driscoll D J, Offord K P, Cha R H, Perrault J, Schaff H V, Puga F J, Danielson G K. J Thorac Cardiovasc Surg. 1996;  112 672-680
  • 18 Fishberger S B, Wernovsky G, Gentles T L. Factors that influence the development of atrial flutter after the Fontan operation.  J Thorac Cardiovasc Surg. 1997;  113 80-86
  • 19 Bridges N D, Mayer J E, Lock J E. Effect of baffle fenestration on outcome of the modified Fontan operation.  Circulation. 1992;  86 1762-1769

John Hess MD, PhD, FESC 

Deutsches Herzzentrum München

Lazarettstrasse 36, 80646 München, Germany

Email: HESS@dhm.mhn.de

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