Operação de Fontan: uma técnica em evolução

Abstract

Objectives: Recent experimental flow studies based on angiography and magnetic resonance have shown that total cavopulmonary anastomosis (TCPA) is a valid concept for surgical treatment of many congenital heart defects, but there is not agreement of the best surgical arrangement. The aim of this study is to assess the immediate results with three different techniques of TCPA.Methods: Clinical study of all TCPA performed from January 2005 to July 2008; there were 40 patients, all with previous Glenn anastomosis, with mean age of 6.4 ± 3.2 years. Three different techniques were employed: Group 1 (G1) lateral tunnel, Group 2 (G2) extracardiac conduits, Group 3 (G3) intracardiac conduit directed to the left pulmonary branch. All patients had a fenestration performed and pre-and postoperative variables were assessed.Results: G1 had 11 patients, G2 10 patients and G3 19 patients. Preoperative variables were similar in the 3 groups (P>0.05). Surgical mortality was higher in Groups 1 and 2 (9.1% and 10%) compared to Group 3 (0%) but there was no statistical significance (P=0.3841). Pleural effusion was absent in Group 3 (0%), which was statistically significant in relation to the other groups (P=0.0128). The length of hospital stay was also significantly lower in G3 (8 days) in relation to G1 (18 days) and G2 (13 days) (P=0.0164). Conclusion:Intracardiac TCPA was associated with lower postoperative morbidity and is currently our preferred technique on total cavopulmonary anastomosis. Rev Bras Cir Cardiovasc 2009; 24(4): 463-469 technique in which a olytetrafluoroethylene (PTFE) conduit is placed between the inferior vena cava and pulmonary artery, through the right atrium via the foramen ovale into the left atrium roof, where it is exteriorized and sutured to the trunk or left pulmonary artery branch. This technique allowed to reach the left pulmonary artery branch with a prosthesis smaller, with fewer curves and angles, thus minimizing the presence of inflexible material in the system. The aim of this study was to review the immediate results of patients undergoing the Fontan operation at a single institution with three models of total cavopulmonary anastomosis. FANTINI, FA ET AL -Fontan operation: a technique in evolution METHODS Study designWe performed clinical trial with 40 patients with univentricular physiology undergoing the Fontan operation in Biocor Institute,

Criss-cross heart: report of two cases, anatomic and surgical description and literature review

“…The images acquired with the MRI show in detail all the heart components and simultaneously clarifies the changes in the AV connections by being able to diagnose abnormalities of heart rotation [58].…”

“…The natural history of patients is unfavorable without surgical treatment, 64% of deaths occurring in childhood, with 50% still in the neonatal period [58,59]. The surgical management of patients with criss-cross heart consists of the repair of major and limiting malformation, not being ventricular rotation itself the reason for the correction.…”

Cirurgia cardíaca pediátrica: o que esperar da intervenção fisioterapêutica?

“…One example is a possible evolution of pulmonary hypertension, resulting from the adaptation of pulmonary flow postoperatively, a situation that restricts sudden maneuvers of physiotherapy [4,8,16,[19][20][21].…”

Complicação pós-operatória de Fontan: fluxo pulmonar anterógrado

“…The presence of additional pulmonary flow in Fontan operations causes a competition between the pulmonary flow and venous return of vene cave, leading into increased pulmonary pressure, venous stasis and Fontan circulation failure [2].…”