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

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Author home page(s): Christian Kreutzer Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kreutzer, C. Search for Related Content PubMed PubMed Citation Articles by Kreutzer, C. Related Collections Related Article

Ann Thorac Surg 2004;78:2211
© 2004 The Society of Thoracic Surgeons

---

Correspondence

Reply

Division of Cardiovascular Surgery, Ricardo Gutierrez Children's Hospital, Gallo 13300, 1425 Buenos Aires,, Argentina

ckreutz{at}intramed.net.ar

To the Editor:

I recognize the value of the comments from Drs Giamberti and Frigiola regarding the technique of fenestration in the extracardiac-conduit Fontan-Kreutzer operation. Their technique of fenestration seems simple and reproducible, but I disagree completely with the concept that atrial arrhythmias are due only to atrial enlargement. There are consistent data in the literature, especially from the group in St. Louis [1–3], indicating that atrial incisions per se are substrate for reentrant tachycardia. I believe, as do many others [4], that the best thing that can and should be done to prevent atrial arrhythmias in the Fontan-Kreutzer procedure is not to touch the right atrium and to avoid chronic ventricular volume loading by performing right heart bypass using the Glenn and extracardiac-conduit procedures as early in life as possible.

In our technique, the pericardial skirt is sutured to caval tissue, thus allowing complete preservation of atrial tissue without atrial scars [5]. The incidence of atrial arrhythmias in our 5-year experience (1998 to 2003) with 67 patients with extracardiac conduits was less than 10% during follow-up. The concept of having a univentricular heart with all chambers at normal volume and pressure and without scars seems to be the perfect scenario for long-standing good functional status and freedom from arrhythmia.

References

1. Rodefeld MD, Gandhi SK, Huddleston CB, et al. Anatomically based ablation of atrial flutter in an acute canine model of the modified Fontan operation. J Thorac Cardiovasc Surg. 1996;112:898–907[Abstract/Free Full Text]
2. Bromberg BI, Schuessler RB, Gandhi SK, Rodefeld MD, Boineau JP, Huddleston CB. A canine model of atrial flutter following the intra-atrial lateral tunnel Fontan operation. J Electrocardiol. 1998;30(Suppl):85–93
3. Gandhi SK, Bromberg BI, Schuessler RB, et al. Characterization and surgical ablation of atrial flutter after the classic Fontan repair. Ann Thorac Surg. 1996;61:1666–1679[Abstract/Free Full Text]
4. Petrossian E, Reddy VM, McElhinney DB, et al. Early results of the extracardiac conduit Fontan operation. J Thorac Cardiovasc Surg. 1999;117:688–696[Abstract/Free Full Text]
5. Kreutzer C, Schlichter AJ, Simon JL, Conejeros Parodi WM, Blunda C, Kreutzer GO. A new method for reliable fenestration in extracardiac conduit fontan operations. Ann Thorac Surg. 2003;75:1657–1659[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Author home page(s): Christian Kreutzer Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kreutzer, C. Search for Related Content PubMed PubMed Citation Articles by Kreutzer, C. Related Collections Related Article