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Ann Thorac Surg 1996;62:1266-1267
© 1996 The Society of Thoracic Surgeons

Discussion

Discussion

The first 20% of the full text of this article appears below.

See also page 1261.

DR CHARLES B. HUDDLESTON (St. Louis, MO): It is certainly a pleasure to discuss this paper. Doctor Laschinger has presented an extension of a proposal that was first made by Dr Marcelletti about an extracardiac type of Fontan connection. This just represents another one of the modifications from Dr Fontan's original work and I think has a quite promising future for these patients.

I agree with the advantages proposed by Dr Laschinger of this modification and would add that this may reduce the risk of systemic emboli by not having any foreign material whatsoever inside the heart as opposed to the total cavopulmonary connection, which generally has a large baffle of polytetrafluoroethylene.

I have a few questions. First, do you anticoagulate your patients? Many have proposed using aspirin and some even warfarin for the intracardiac baffles. We currently use aspirin even for our extracardiac patients.

You have described the use of pericardium in some of these patients to form the extracardiac Fontan connection, and I have some concerns about its use because it has been found to both shrink and stretch when it is not treated with glutaraldehyde. Can you comment on that?

I have some questions about the specifics of the suture lines in the right atrium. Are these full-thickness bites or just partial thickness in the epicardium? What is the relationship of the suture line to the crista terminalis? At least in our research laboratory we found that any suture manipulation in the area of the crista terminalis can lead to the development of atrial flutter in acute canine models.

You alluded . . . [Full Text of this Article]


Related Article

Intermediate Results of the Extracardiac Fontan Procedure
John C. Laschinger, J. Mark Redmond, Duke E. Cameron, Jean S. Kan, and Richard E. Ringel
Ann. Thorac. Surg. 1996 62: 1261-1266. [Abstract] [Full Text]





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Copyright © 1996 by The Society of Thoracic Surgeons.