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Related Experiment Videos

Sinus node function after a systematically staged Fontan procedure

M I Cohen1, G Wernovsky, V L Vetter

  • 1Division of Cardiology, Children's Hospital of Philadelphia, PA 19104, USA. cohenmi@chop.edu

Circulation
|December 16, 1998
PubMed
Summary
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Sinus node dysfunction is common after staged Fontan procedures, affecting 23% early and 44% late. Early dysfunction and longer follow-up increase the risk of persistent sinus node dysfunction.

Area of Science:

  • Pediatric Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Sinus node dysfunction (SND) occurs in 13-16% of Fontan patients.
  • Concern exists that intermediate cavopulmonary connections may increase SND risk.
  • Limited data available on SND incidence in routinely staged Fontan operations.

Purpose of the Study:

  • To determine early and late incidences of SND in patients undergoing staged Fontan operations after a hemi-Fontan procedure.
  • To assess the impact of staged palliation on sinus node function.

Main Methods:

  • Retrospective review of hospital records and ECGs for 287 patients undergoing staged Fontan operations (1990-1995).
  • Cross-sectional analysis of 220 surviving patients to determine late SND incidence.

Related Experiment Videos

  • Assessment of sinus node function before hemi-Fontan, after hemi-Fontan, early post-Fontan, and late follow-up.

    • Main Results:

    • SND was present in 7% pre-hemi-Fontan and 15% post-hemi-Fontan.
    • 23% experienced SND in the early postoperative period after the Fontan procedure.
    • Late SND incidence was 44% in patients followed >4 years; 6.7% received pacemakers, 4.1% had atrial flutter.

    Conclusions:

    • Perioperative SND is frequent following both hemi-Fontan and Fontan procedures.
    • While many regain sinus node function between stages, late SND is common.
    • Early SND and longer follow-up are associated with increased likelihood of late sinus node dysfunction.