ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Kirk R. Kanter
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kanter, K. R.
Right arrow Articles by Raviele, A. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kanter, K. R.
Right arrow Articles by Raviele, A. A.

Ann Thorac Surg 1999;68:969-974
© 1999 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Importance of acquired systemic-to-pulmonary collaterals in the Fontan operation

Kirk R. Kanter, MDa, Robert N. Vincent, MDb, Anthony A. Raviele, MDb

a Division of Cardio-Thoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
b The Children’s Heart Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA

Address reprint requests to Dr Kanter, Division of Cardio-Thoracic Surgery, Emory University School of Medicine, 1365 Clifton Rd, Atlanta, GA 30322
e-mail: kkanter{at}emory.org

Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.

Background. Children with chronic cyanotic heart disease often develop systemic-to-pulmonary collateral arteries that can be deleterious at the time of a Fontan procedure due to excessive pulmonary blood flow. We therefore occlude all significant collaterals during cardiac catheterization.

Methods. From June 1993 to May 1998, 93 children aged 1.5 to 15.8 years (median 2.5 years) underwent a fenestrated lateral tunnel Fontan procedure. Eighty-nine (96%) had a previous bidirectional Glenn anastomosis, including 31 (33%) with a Norwood procedure.

Results. Preoperatively, 33 children (35%) required occlusion of 1 to 11 (mean 3.6) collateral vessels. Two of the three perioperative deaths (operative survival 97%) were due to excessive pulmonary blood flow from unrecognized collaterals in one and uncontrollable collaterals in the other. Postoperatively, 19 children (20%) required coil occlusion of 1 to 21 (mean 5.6) collaterals for elevated pulmonary artery pressures, heart failure, or prolonged chest tube drainage. Duration of inotropic support, postoperative ventilation, intensive care unit stay, and postoperative hospitalization were all significantly longer in the patients who had postoperative occlusion of collaterals. On follow-up of 2 to 67 months (mean 35 months), there have been four late deaths (two infections, two heart failures); 6 patients underwent successful cardiac transplantation for refractory heart failure. All 8 patients with ventricular failure required occlusion of significant collaterals postoperatively.

Conclusions. Hemodynamically significant collaterals are not uncommon in Fontan candidates, and aggressive control can result in good operative and medium-term survival. After the Fontan, significant collaterals may be a marker for eventual cardiac failure because 8 of 18 patients requiring postoperative coils went on to transplantation or died of heart failure.




This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
K. Januszewska, A. Stebel, and E. Malec
Consequences of Right Ventricle to Pulmonary Artery Shunt at the First Stage for the Fontan Operation
Ann. Thorac. Surg., November 1, 2007; 84(5): 1611 - 1617.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T.-Y. Hsia and P. J. Gruber
Factors Influencing Neurologic Outcome After Neonatal Cardiopulmonary Bypass: What We Can and Cannot Control
Ann. Thorac. Surg., June 1, 2006; 81(6): S2381 - S2388.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
K. Suda, M. Matsumura, A. Sano, S. Yoshimura, and T. Ishii
Hemoptysis From Collateral Arteries 12 Years After a Fontan-Type Operation
Ann. Thorac. Surg., January 1, 2005; 79(1): e7 - e8.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
Y. Ootaki, M. Yamaguchi, N. Yoshimura, S. Oka, M. Yoshida, and T. Hasegawa
Vascular endothelial growth factor in children with congenital heart disease
Ann. Thorac. Surg., May 1, 2003; 75(5): 1523 - 1526.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. M. Bradley, M. M. McCall, J. J. Sistino, and W. A.K. Radtke
Aortopulmonary collateral flow in the Fontan patient: does it matter?
Ann. Thorac. Surg., August 1, 2001; 72(2): 408 - 415.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
J. A. Gaca, W. I. Douglas, and S. D. Barnes
Anesthetic Implications of the Fontan Procedure for Single Ventricle Physiology
Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2001; 5(1): 31 - 39.
[Abstract] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1999 by The Society of Thoracic Surgeons.