HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pearl, J. M. Articles by Chang, P. A. Search for Related Content PubMed PubMed Citation Articles by Pearl, J. M. Articles by Chang, P. A.

The Annals of Thoracic Surgery, Vol 57, 611-614, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

Spontaneous closure of fenestrations in an interatrial Gore-Tex patch: application to the Fontan procedure

JM Pearl, H Laks, S Barthell, DC Drinkwater Jr, ER Capouya and PA Chang
Department of Surgery, University of California, Los Angeles Medical School.

The concept of the partial Fontan procedure, first described with the adjustable atrial septal defect (ASD) and more recently with the fenestrated technique, has become an accepted approach for the management of high-risk patients undergoing the Fontan procedure. Experience with both techniques has shown that a patent ASD placed in a prosthetic interatrial baffle may close spontaneously over a period of weeks to months. The mechanism and timing of spontaneous closure, as well as the effect of antiplatelet therapy on this process, are poorly understood. To better define this process, the interatrial septum of 15 mongrel dogs was excised and replaced with a fenestrated Gore-Tex (W.L. Gore, Flagstaff, AZ) patch. Postoperative echocardiography confirmed the patency of the ASD and left-to-right shunting. Animals were sacrificed 4 to 6 weeks postoperatively, or sooner if infection or other postoperative complications developed. Eight animals underwent no antiplatelet or anticoagulation therapy postoperatively, and 7 received antiplatelet therapy with aspirin. Patches were removed at the end of the study period and analyzed. By 6 weeks, all 2.7-mm and 4-mm holes had closed spontaneously in all animals that had not received antiplatelet therapy. The earliest closure occurred at 1 week. With antiplatelet therapy, hole closure was found to be delayed but not prevented, and was complete by 6 weeks in all but 1 animal. Histologic examination of the explanted patches revealed that closure was accomplished primarily through the ingrowth of fibrous tissue, accompanied by an inflammatory cell infiltrate.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				M. Pawelec-Wojtalik, J. Nozynski, M. Wojtalik, M. Piaszczynski, R. Surmacz, D. Bukowska, and W. Mrowczynski Is device closure for direct access valved stent implantation safe? Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 4 - 9. [Abstract] [Full Text] [PDF]

				R. Kaulitz, G. Ziemer, T. Paul, M. Peuster, H. Bertram, and G. Hausdorf Fontan-type procedures: residual lesions and late interventions Ann. Thorac. Surg., September 1, 2002; 74(3): 778 - 785. [Abstract] [Full Text] [PDF]

				M. L. Jacobs, K. K. Pourmoghadam, E. M. Geary, A. T. Reyes, N. Madan, L. B. McGrath, and J. W. Moore Fontan's operation: is aspirin enough? Is coumadin too much? Ann. Thorac. Surg., January 1, 2002; 73(1): 64 - 68. [Abstract] [Full Text] [PDF]

				M Tofeig, K P Walsh, C Chan, E Ladusans, G Gladman, and R Arnold Occlusion of Fontan fenestrations using the Amplatzer septal occluder Heart, April 1, 1998; 79(4): 368 - 370. [Abstract] [Full Text]

				J. Rychik, J. J. Rome, and M. L. Jacobs Late Surgical Fenestration for Complications After the Fontan Operation Circulation, July 1, 1997; 96(1): 33 - 36. [Abstract] [Full Text]