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Renewal of the Fontan circulation with concomitant surgical intervention for atrial arrhythmia
Y Kawahira1, H Uemura, T Yagihara
1Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan. ykawahir@hsp.ncvc.go.jp
Insights
Surgical intervention for atrial arrhythmia in Fontan procedure patients can restore sinus rhythm. Combining total cavopulmonary connection with arrhythmia surgery offers an effective treatment for long-term complications.
Area of Science:
- Congenital Heart Disease
- Pediatric Cardiology
- Cardiac Surgery
Background:
- Atrial arrhythmia is a significant long-term complication following the Fontan procedure.
- Patients with atriopulmonary connection Fontan procedure are at risk for persistent atrial fibrillation or flutter.
Purpose of the Study:
- To evaluate the effectiveness of converting to total cavopulmonary connection (TCPC) concurrently with surgical intervention for atrial arrhythmia.
- To assess outcomes in patients with long-term atrial arrhythmia after an initial Fontan procedure.
Main Methods:
- Four patients with atrial arrhythmia post-Fontan (atriopulmonary connection) underwent conversion to TCPC and arrhythmia surgery.
- Surgical intervention aimed to restore normal sinus rhythm and improve Fontan circulation.
Main Results:
- Sinus rhythm was restored in all patients post-intervention.
- One patient experienced transient atrial fibrillation requiring defibrillation.
- Cardiac index improved and systemic venous pressure decreased post-TCPC conversion.
- All patients achieved New York Heart Association functional class I.
Conclusions:
- The combination of TCPC conversion and atrial arrhythmia surgery is effective for managing long-term arrhythmias after Fontan procedure.
- Timely and appropriate application of this combined approach is crucial for favorable outcomes.
Background:
Atrial arrhythmia remains one of the major complications in the longer term after the Fontan procedure.
Methods:
Conversion to total cavopulmonary connection was carried out concomitantly with surgical intervention for atrial arrhythmia in 4 patients undergoing the Fontan procedure by atriopulmonary connection and having continual atrial fibrillation or flutter in the longer term after the initial procedure.
Results:
The surgical intervention restored sinus rhythm. Transient atrial fibrillation occasionally occurred after the reoperation in 1 patient in whom duration of preoperative arrhythmic period had been 6 years, and defibrillation was needed twice. In the other 3 patients, no episodes of paroxysmal arrhythmia have been noted. Subsequent to renewal of the Fontan circulation, cardiac index increased, with systemic venous pressure decreasing. All 4 patients are currently doing well with their functional status of New York Heart Association functional class I.
Conclusions:
Combination of conversion to total cavopulmonary connection and concomitant surgical intervention for atrial arrhythmia is effective, when used appropriately and in a timely manner in patients with atrial arrhythmia in the longer term after the initial Fontan procedure by atriopulmonary connection.