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Francis X. Downey
Serafin Y. DeLeon
David O. Monson
Norbert E. Baumgartner
Henry J. Sullivan
Roque Pifarré
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Ann Thorac Surg 1994;58:1527-1529
© 1994 The Society of Thoracic Surgeons

Articles

Disruption of sutured pulmonary valve in fontan operation

Francis X. Downey, MDa,b, Serafin Y. DeLeon, MD*,a,b, David O. Monson, MDa,b, Norbert E. Baumgartner, MDa,b, Robert C. Lichtenberg, MDa,b, Henry J. Sullivan, MDa,b, Roque Pifarré, MDa,b

a Departments of Thoracic and Cardiovascular Surgery and Pediatrics, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
b Departments of Thoracic and Cardiovascular Surgery and Pediatrics, Rush Medical College, Chicago, Illinois USA

Accepted for publication March 2, 1994.

* Address reprint requests to Dr DeLeon, Pediatric Cirdiac Surgery, Loyola University Medical Center, 2160 S First Ave, Maywood, IL 60153.

Two patients who had undergone a Fontan operation presented late with considerable disruption of a sutured pulmonary valve. Both patients had increasing ascites, decreased exercise tolerance, atrial arrhythmias, high right atrial pressure, and a large ratio of pulmonary blood flow to systemic blood flow. At operation, the main pulmonary artery was closed either by suturing the anterior and posterior walls together immediately distal to the pulmonary valve or by reinforcing the resutured pulmonary valve with a polytetrafluoroethylene patch. Both patients had an uneventful postoperative course, with disappearance of the symptoms and return of sinus rhythm. Although it is tempting to simply suture the usually thickened pulmonary valve in (he Fontan operation, approximation of the pulmonary artery walls or patch reinforcement is necessary to minimize disruption.






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Copyright © 1994 by The Society of Thoracic Surgeons.