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Fontan-type procedures: residual lesions and late interventions
Renate Kaulitz1, Gerhard Ziemer, Thomas Paul
1Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Germany. renate.kaulitz@med.uni-tuebingen.de
The Annals of Thoracic Surgery
|September 20, 2002
Summary
Reoperations after Fontan-type procedures are uncommon, primarily involving Fontan conversion. Regular cardiac catheterization aids in identifying and managing late hemodynamic and electrophysiological complications.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- The Fontan procedure is a palliative surgery for complex congenital heart defects.
- Long-term outcomes require understanding of late complications.
Purpose of the Study:
- To determine the incidence of hemodynamic and electrophysiological abnormalities after Fontan-type procedures.
- To identify interventions needed during long-term follow-up.
Main Methods:
- Retrospective analysis of 88 patients with >5 years follow-up after Fontan-type procedures.
- Cardiac catheterization for protocol or symptomatic evaluation.
Main Results:
- 82% freedom from reoperation at 5 years, decreasing to 76% at 8 years.
- 11% required pacemaker for bradycardia; transcatheter interventions common for fenestration and collateral occlusion.
- Late reoperations included Fontan conversion and management of arteriovenous malformations.
Conclusions:
- Reoperations are rare, mainly Fontan conversions; detailed angiographic evaluation is crucial.
- Transcatheter interventions effectively manage late complications, improving Fontan circulation.
- Regular postoperative cardiac catheterization is recommended for long-term Fontan patient management.