PMID- 19713119
OWN - NLM
STAT- MEDLINE
DCOM- 20100226
LR  - 20191210
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 36
IP  - 4
DP  - 2009 Oct
TI  - Clinical outcome of the Fontan operation in patients with impaired ventricular 
      function.
PG  - 683-7
LID - 10.1016/j.ejcts.2009.04.042 [doi]
AB  - OBJECTIVE: Although a staged Fontan strategy allows for an excellent outcome in 
      high-risk patients, an impaired ventricular function remains a significant factor 
      of early/late mortality and morbidity. This study evaluated the clinical outcome 
      of the Fontan operation in patients with impaired ventricular function. METHODS: 
      A retrospective review was performed on 217 patients who had undergone the Fontan 
      operation between 1991 and 2007. RESULTS: Twenty-nine (13%) of the 217 patients 
      had an impaired ventricular function (ejection fraction (EF) <50%). The median 
      age at the time of the operation was 3 (range: 1-31 years) years. There were five 
      adult patients. The ventricular morphology was right in 20 patients (including 
      five hypoplastic left heart syndrome (HLHS)) and others (left and two-ventricle) 
      in nine patients. Heterotaxy syndrome was present in eight patients. Previous 
      surgical interventions included bidirectional Glenn anastomoses in 24, modified 
      Blalock-Taussig shunts in two and pulmonary artery banding in two. The 
      preoperative EF was 43+/-6%. Significant (moderate or severe) atrioventricular 
      valve regurgitation was noted in four patients. The percutaneous oxygen 
      saturation (SpO(2)) was 82+/-5%. The pulmonary artery pressure and pulmonary 
      artery index were 11+/-3 mmHg and 296+/-102 mm(2)m(-2), respectively. All 29 
      patients underwent the Fontan operation without any early mortality. There were 
      two late mortalities and two re-operations. EF was maintained at 59+/-15% at a 
      median follow-up of 7.5 (range: 1-19) years. The percent normal systemic 
      ventricular end-diastolic volume decreased from 174+/-95% to 124+/-39% (p<0.05). 
      The SpO(2) increased to 92+/-2%. The mean cardiothoracic ratio in chest X-ray and 
      B-type natriuretic peptide were 51% (range: 35-68%) and 22 pgml(-1) (range: 9-382 
      pgml(-1)), respectively. Three patients developed congestive heart failure, seven 
      had arrhythmia and two developed protein-losing enteropathy. The New York Heart 
      Association (NYHA) class functional class is I in 21 patients, II in five and III 
      in one. CONCLUSIONS: Acceptable clinical outcomes were observed at an 
      intermediate follow-up of the Fontan operation in patients with an impaired 
      ventricular function.
FAU - Kotani, Yasuhiro
AU  - Kotani Y
AD  - Department of Cardiovascular Surgery, Okayama University Graduate School of 
      Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama City, 
      Okayama 700-8558, Japan.
FAU - Kasahara, Shingo
AU  - Kasahara S
FAU - Fujii, Yasuhiro
AU  - Fujii Y
FAU - Yoshizumi, Ko
AU  - Yoshizumi K
FAU - Oshima, Yu
AU  - Oshima Y
FAU - Otsuki, Shin-Ichi
AU  - Otsuki S
FAU - Akagi, Teiji
AU  - Akagi T
FAU - Sano, Shunji
AU  - Sano S
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20090826
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Child
MH  - Child, Preschool
MH  - Double Outlet Right Ventricle/surgery
MH  - Epidemiologic Methods
MH  - Female
MH  - Fontan Procedure/*methods
MH  - Heart Defects, Congenital/*surgery
MH  - Heart Ventricles/abnormalities/surgery
MH  - Humans
MH  - Hypoplastic Left Heart Syndrome/surgery
MH  - Infant
MH  - Male
MH  - Oxygen/blood
MH  - Partial Pressure
MH  - Stroke Volume
MH  - Treatment Outcome
MH  - Ventricular Dysfunction/complications/*surgery
MH  - Young Adult
EDAT- 2009/08/29 09:00
MHDA- 2010/02/27 06:00
CRDT- 2009/08/29 09:00
PHST- 2008/09/15 00:00 [received]
PHST- 2009/04/14 00:00 [revised]
PHST- 2009/04/17 00:00 [accepted]
PHST- 2009/08/29 09:00 [entrez]
PHST- 2009/08/29 09:00 [pubmed]
PHST- 2010/02/27 06:00 [medline]
AID - S1010-7940(09)00441-2 [pii]
AID - 10.1016/j.ejcts.2009.04.042 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2009 Oct;36(4):683-7. doi: 10.1016/j.ejcts.2009.04.042. 
      Epub 2009 Aug 26.