Extending the limits for modified Fontan procedures

Mayer, John E.; Helgason, Hróðmar; Jonas, Richard A.; Lang, Peter; Vargas, Florentino J.; Cook, Nancy R.; Castañeda, Aldo R.

doi:10.1016/s0022-5223(19)35818-0

Cited by 218 publications

(34 citation statements)

References 9 publications

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“…Interval data were analysed with unpaired Student’s t ‐test. Categorical variables were analysed using c 2 analysis. A P ‐value of < 0.05 was considered significant.…”

Section: Discussionmentioning

confidence: 99%

“…Retrospective analysis to correlate age at operation with survival has inherent problems 2,4,5 . Considering the substantial mortality rate that may occur before a Fontan operation, patients who survive beyond 2 years of age without operation are likely to be inherently different from patients who do not survive.…”

Section: Caveats Of Study Designmentioning

confidence: 99%

“…Since the first univentricular repair for physiological correction of tricuspid atresia was carried out by Fontan and Baudet, 1 the procedure has been modified and expanded by various groups in terms of age, anomalies of systemic and pulmonary venous connection, pulmonary artery deformity and pulmonary vascular haemodynamics 2–10 . Since 1994, we have been routinely fenestrating all patients undergoing univentricular repair, after results with fenestration demonstrated an improvement in outcome 11 .…”

mentioning

confidence: 99%

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Univentricular repair in children under 2 years of age: Early and midterm results

Chowdhury

Airan

Sharma

et al. 2001

Heart, Lung and Circulation

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“…Interval data were analysed with unpaired Student’s t ‐test. Categorical variables were analysed using c 2 analysis. A P ‐value of < 0.05 was considered significant.…”

Section: Discussionmentioning

confidence: 99%

Section: Caveats Of Study Designmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Univentricular repair in children under 2 years of age: Early and midterm results

Chowdhury

Airan

Sharma

et al. 2001

Heart, Lung and Circulation

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“…[1][2][3][4][5][6] In patients with single-ventricle physiology who are destined for a Fontan procedure, even a slight elevation in PVR is an important risk factor. [7][8][9] Generally, the Fontan procedure is not indicated in patients with a PVR of greater than 2 Wood units and a mean pulmonary arterial pressure (PAP) higher than 15 mmHg. 7,9,10 We have performed the Fontan procedure in patients whose PVR was less than 3 Wood units and in whom the PAP was lower than 20 mmHg provided that other criteria, such as the pulmonary artery (PA) index, were fulfilled.…”

mentioning

confidence: 99%

“…[7][8][9] Generally, the Fontan procedure is not indicated in patients with a PVR of greater than 2 Wood units and a mean pulmonary arterial pressure (PAP) higher than 15 mmHg. 7,9,10 We have performed the Fontan procedure in patients whose PVR was less than 3 Wood units and in whom the PAP was lower than 20 mmHg provided that other criteria, such as the pulmonary artery (PA) index, were fulfilled. 11 These selection criteria preclude progression towards a Fontan procedure in patients for whom this procedure is the only surgical treatment to eliminate cyanosis.…”

mentioning

confidence: 99%

Effect of beraprost sodium on pulmonary vascular resistance in candidates for a Fontan procedure: A preliminary study

Takahashi¹,

Mori²,

Yamamura³

et al. 2003

Pediatr Int

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Objective : Although long‐term prostacyclin(PGI2) therapy in patients with severe pulmonary hypertension (PH)reduces pulmonary vascular resistance (PVR), there have been noreports on its therapeutic effects in patients with mild PH. Weinvestigated the chronic effect of beraprost sodium (BPS), an oralPGI2 analog, in children with mild PH. Methods : We studied 20 patients who weredestined for a Fontan procedure with a mean pulmonary arterial pressure(PAP) of>20 mmHg and/or PVR of>3.0 Woodunits. Both the PAP and the PVR in these cases were too high forpatients to undergo a successful Fontan procedure. Seven patientsreceived BPS (PG group) and 13 did not (control group). All patientsunderwent repeat cardiac catheterization to examine pulmonary hemodynamics. Results : In the PG group, the pulmonary‐to‐systemicflow ratio (Qp/Qs) did not change after BPS administration(1.1 ± 0.6 vs 1.3 ± 0.9);however, the mean PAP decreased significantly (25.3 ± 8.2 vs 19.9 ± 6.5 mmHg; P < 0.05),as did PVR (3.7 ± 1.3 vs 2.3 ± 0.9 Woodunits; P < 0.05), whereas the pulmonaryartery (PA) index increased significantly (312 ± 136 vs 375 ± 165; P < 0.05).In the control group, the mean PAP decreased significantly (24.9 ± 4.7 vs 19.8 ± 6.3 mmHg; P < 0.05)and the PA index increased significantly (295 ± 72 vs 362 ± 114; P < 0.05).No significant changes in Qp/Qs (1.5 ± 0.8 vs 1.4 ± 0.6)or PVR (2.9 ± 1.3 vs 2.5 ± 0.8 Woodunits) were observed. Conclusion : We conclude that long‐termBPS administration probably reduces PVR in potential candidates fora Fontan procedure with mild PH. This treatment would reduce therisks associated with the Fontan procedure and would also improveits outcome.

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Surgical Management of Congenital Heart Disease in the 1990s

Cohen¹

1992

Arch Pediatr Adolesc Med

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Extending the limits for modified Fontan procedures

Cited by 218 publications

References 9 publications

Univentricular repair in children under 2 years of age: Early and midterm results

Univentricular repair in children under 2 years of age: Early and midterm results

Effect of beraprost sodium on pulmonary vascular resistance in candidates for a Fontan procedure: A preliminary study

Surgical Management of Congenital Heart Disease in the 1990s

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