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Aortopulmonary collateral flow in the Fontan patient: does it matter?
S M Bradley1, M M McCall, J J Sistino
1Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston 29425, USA. bradlesm@musc.edu
The Annals of Thoracic Surgery
|August 23, 2001
Summary
Aortopulmonary collaterals (APCs) are common in Fontan procedures. However, the extent of APC flow does not significantly impact the outcomes of the Fontan procedure in well-prepared patients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- The impact of aortopulmonary collaterals (APCs) on Fontan procedure outcomes remains uncertain.
- Understanding APCs is crucial for optimizing Fontan procedure results.
Purpose of the Study:
- To determine the incidence and extent of APC flow in Fontan procedure patients.
- To identify risk factors associated with APC flow.
- To assess the effect of APC flow on Fontan procedure outcomes.
Main Methods:
- Directly measured APC flow in 32 patients during Fontan procedures.
- Expressed APC flow as a percentage of total cardiopulmonary bypass pump flow.
- Data collected between July 1997 and September 2000.
Main Results:
- APC flow varied widely, from 9% to 49% (median 18%) of total pump flow.
- Higher preoperative oxygen saturation and pulmonary-to-systemic flow ratio correlated with increased APC flow.
- No significant effect of APC flow on postoperative pressures, effusions, or resource utilization was observed.
Conclusions:
- APC flow is consistently present in patients undergoing Fontan procedures, with significant variability.
- Increased APC flow did not adversely affect the outcomes of the Fontan procedure in this cohort.
- Findings are applicable to well-prepared patients; results may differ in higher-risk individuals.