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Fontan extracardiac tunnel connection: fenestration or not?
Song Fu1, Klaus Valeske, Hakan Akinturk
1Department of Childrens' Heart Center, BAYI Children's Hospital, General Hospital of Beijing Military Command, Beijing 100700, China.
Chinese Medical Journal
|January 19, 2010
Summary
Fenestrating extracardiac connections (EC) in patients with univentricular heart disease reduces early mortality and pulmonary artery pressure. Fenestration closure later improves arterial oxygen saturation and exercise tolerance.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Hemodynamics
Background:
- Extracardiac connection (EC) with fenestration creates a right-to-left shunt, increasing cardiac output but causing mild oxygen desaturation.
- Fenestration closure can be performed after assessing hemodynamic stability.
- This study compares outcomes of EC with and without fenestration in univentricular heart disease.
Purpose of the Study:
- To compare the outcomes of extracardiac connection (EC) with or without fenestration in patients with univentricular heart disease.
- To evaluate the impact of fenestration on mortality, pulmonary artery pressure, and oxygen saturation.
Main Methods:
- Ninety-five patients with univentricular heart disease underwent EC using Gore-Tex conduits.
- Patients were divided into two groups: Group A (with fenestration) and Group B (without fenestration).
- Outcomes including mortality, pulmonary artery pressure, oxygen saturation, thrombosis, and neurological issues were compared. 23 patients in Group A had fenestration closure.
Main Results:
- Group B (no fenestration) had significantly higher mortality (3%) and postoperative mean pulmonary artery pressure (15.1 mmHg) compared to Group A (0% mortality, 13.2 mmHg).
- No significant differences were observed in postoperative oxygen saturation, thrombosis, neurological problems, or loss of sinus rhythm between the groups.
- Fenestration closure in Group A was performed interventionally after a mean of 20-22 months.
Conclusions:
- Fenestrating an extracardiac tunnel improves acute postoperative mortality by increasing cardiac output.
- The right-to-left shunt from fenestration does not appear to cause postoperative morbidity.
- Interventional closure of fenestration can be performed once hemodynamics stabilize to enhance arterial oxygen saturation and exercise tolerance.
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