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The Annals of Thoracic Surgery, Vol 47, 533-538, Copyright © 1989 by The Society of Thoracic Surgeons
MN Ilbawi, FS Idriss, SY DeLeon, VA Kucich, AJ Muster, MH Paul and VR Zales
Eight anesthetized dogs underwent closure of the tricuspid valve and a
Fontan procedure, and the right ventricular cavity was reduced in stepwise
fashion. There was an increase in right atrial pressure from 9.3 +/- 2.2 to
14.1 +/- 2.4 mm Hg (p less than 0.001), a decrease in pulmonary artery
pulse pressure from 10.8 +/- 2.2 to 6.8 +/- 2.2 mm Hg (p less than 0.01),
and a decrease in cardiac index from 2.7 +/- 0.3 to 2.2 +/- 0.2 L/min/m2 (p
less than 0.001) when the ventricular size was dropped from 50% to 25% of
normal. The difference between mean pulmonary artery pressure and mean
right atrial pressure, which reflects the positive stroke work index of the
ventricle, disappeared once the right ventricular cavity was reduced to 25%
of normal (15.0 +/- 6.1 versus 14.1 +/- 2.4 mm Hg; p = not significant).
Experimental results were correlated with postoperative catheterization
data from 19 patients with tricuspid atresia who had the Fontan operation.
Mean right atrial pressure was 18 +/- 4.6 mm Hg and cardiac index was 2.35
+/- 0.65 L/min/m2 in patients with a direct atrium-pulmonary artery
anastomosis or an atrioventricular anastomosis with a right ventricular
cavity less than 30% of normal versus 13 +/- 3.2 mm Hg and 3.42 +/- 0.46
L/min/m2 for those with an atrioventricular connection and a right
ventricular cavity greater than 30% of normal (p less than 0.05 and p less
than 0.02, respectively). The right ventricle enlarged from 27% +/- 6% of
normal preoperatively to 35% +/- 10% of normal on follow-up (p less than
0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
When should the hypoplastic right ventricle be used in a Fontan operation? An experimental and clinical correlation
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, Illinois 60614.
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