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Circulation, Vol 82, 1681-1689, Copyright © 1990 by American Heart Association
ND Bridges, JE Lock and AR Castaneda
Ventricular dysfunction, elevated pulmonary vascular resistance, and
residual distal pulmonary artery distortion contribute to early mortality
after a Fontan operation; they may be transient or reversible. A baffle
fenestration, allowing right-to-left shunting, maintains cardiac output and
limits right atrial pressure. A baffle fenestration was surgically created
at the time of a modified Fontan repair in 20 consecutive patients. Risk
factors included pulmonary artery pressure of 18 mm Hg or more,
end-diastolic pressure of 12 mm Hg or more, valvar regurgitation, pulmonary
artery distortion, pulmonary vascular resistance of 2 Woods' units or more,
ventricular outflow obstruction, and complex anatomy. Nineteen of 20
patients survived. After the operation, mean arterial oxygen saturation was
86%, mean right atrial pressure was 15 mm Hg, and mean duration of pleural
effusions was 6 days. Twelve of 19 survivors tolerated early test occlusion
and had permanent transcatheter umbrella closure. Four patients failed
early test occlusion, with a significant decrease in venous O2 saturation
and a rise in central venous pressure, due to ventricular dysfunction,
pulmonary artery distortion, or aortopulmonary collaterals. Three of four
had successful late closure of the fenestration after correction of these
abnormalities.
ARTICLES
Baffle fenestration with subsequent transcatheter closure. Modification of the Fontan operation for patients at increased risk
Department of Cardiology, Children's Hospital, Boston, Mass 02115.
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