• Journal of Chest Surgery
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• v.40 no.12
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• pp.805-810
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• 2007

Background: This paper reviews our experience retrospectively to examine the clinical results and effectiveness of lateral tunnel (LT) and extracardiac conduit (ECC) Fontan procedures at a single institution. Material and Method: One hundred and sixty five Fontan procedures were performed (67 LT and 98 ECC) between January 1996 and December 2006. Preoperative and postoperative hemodynamic values, arrhythmia, hospital and intensive care unit stay, chest tube drain, morbidity and mortality were reviewed. Result: The overall operative mortality in the LT and ECC groups was 4.5% (3) and 2.0% (2), respectively. There was a significant difference in the immediate postoperative transpulmonary gradient (LT $8.5{\pm}2.5$ vs ECC $6.6{\pm}2.4$, p-value<0.001) and central venous pressure (LT $18.3{\pm}3.8$ vs ECC $15.6{\pm}2.4$, p-value=0.001) between the two groups. The mean follow-up in the LT and ECC groups was $74.1{\pm}31.5$ and $38.1{\pm}29.1$ months, respectively. There was one late death. The actuarial survival at 10 years in the LT and ECC groups was 92% and 89%, respectively. In arrhythmia, the ECC patients showed a slightly low incidence but the difference was not statistically significant. Conclusion: Both the LT and ECC Fontan procedures showed comparable early and mid-term outcomes in terms of the surgical morbidity and mortality, postoperative hemodynamics, and mid-term survival. The ECC Fontan procedure reduces the risk of arrhythmia in the follow up period.

• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.529-537
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• 2005

Background: Historically the Fontan operation in patients with single ventricle and heterotaxy syndrome has been associated with high mortality because of systemic or pulmonary anomalous venous drainage, incompetent common atrioventricular valve, right ventricle type univentricular heart, and arrhythmia. Material and Method: A retrospective review of 62 patients $(age:\;54.79\pm33.97\;months)$ with heterotaxy syndrome who underwent a extracadiac Fontan operation between 1996 and 2005 was performed. Twenty one patients had left atrial isomerism, and 41 had right isomerism. The Fontan procedure was staged in all but 2 patients, and a fenestration was less placed in left isomerism. Result: Left isomerism was associated more with interrupted inferior vena cava and pulmonary arteriovenous fistula, and right isomerism was associated more with anomalous pulmonary venous drainage, common atrioventricular valve and morphologic right ventricle. There were 3 hospital deaths$(4.8\%)$ and 3 late deaths $(5.2\%)$ with a follow-up duration of $48.8\pm31.0$ months. Eight-year survivals were $90.5\pm6.4\%$ in left isomerism and $88.6\pm5.4\%$ in right isomerism (p=0.94). At 8 years, freedom from reoperation was $73.9\pm11.3\%$ in left isomerism, and $82.3\pm6.7\%$ in right isomerism (p=0.87). Atrioventricular valve regurgitation progressed after Fontan operation in heterotaxy syndrome, and reoperation for pulmonary arteriovenous fistula and permanent pacemaker implantation for sinus node dysfunction were required more in left isomerism. Conclusion: The extracardiac Fontan operation can now be performed in patients with heterotaxy syndrome with excellent survival. However, morbidity in terms of postoperative atrioventricular valve regurgitation, arrhythmia, and pulmonary arteriovenous fistula remains significant.

• Journal of Chest Surgery
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• v.34 no.10
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• pp.781-783
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• 2001

In a patient with single ventricle associated with complex systemic and/or pulmonary venous drainage, intraatrial Fontan procedure is sometimes technically difficult due to the complex spatial relationship between their orifices in the atrium. We report a case of the modified extracardiac conduit Fontan procedure in a patient with a single ventricle in which the inferior vena cava and the hepatic vein drained separately into the atrium and the intraatrial orifice of the hepatic vein was abut to the orifice of the left lower pulmonary vein.

• Journal of Chest Surgery
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• v.21 no.6
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• pp.1124-1136
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• 1988

Massive hemoptysis, usually rapid flooding of tracheobronchial tree and asphyxia, is associated with high mortality. We have controlled massive hemoptysis in two cases with use of bronchial artery angiography & selective bronchial artery embolization with Gelfoam particle. One case was inoperable case that was confirmed as TOF c severe pulmonary artery hypoplasia with massive hemoptysis due to hypertrophied bronchial artery and its collaterals. Another case was congenital ASD with pulmonary Aspergillosis, postop. empyema and BPF associated with massive bleeding due to erosion of hypervascular bronchial artery. We experienced dramatic improvement of general condition and cessation of massive hemoptysis for above two cases. No other problems and complication were noted during postop. hospitalization and follow-up period.

• Journal of Chest Surgery
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• v.28 no.6
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• pp.619-622
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• 1995

We report a successful surgical correction of type II truncus arteriosus without using a extra-cardiac conduit in an 2 month-old infant. The truncal root is transected, and the confluence of branch pulmonary arteries is brought anterior to the aorta by using Lecompte`s maneuver. The aorta is then reconstructed directly with an end-to-end anastomosis. The right ventricular outflow tract is reconstructed by anastomosing the posterior wall of the confluence directly to the upper part of the vertical right ventriculotomy. A monocusp ventricular outflow patch is then placed anteriorly to complete reconstruction of the right ventricular outflow tract. The patient had an uncomplicated postoperative course and was discharged on the 9th postoperative day.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1448-1454
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• 1992

Between July, 1990 and July, 1992, 6 male patients of truncus arteriosus, whose age ranged from 2 months to 18 months, underwent total surgical correction without a extracardiac conduit. Their anatomic types were type I in 3, type II in 2 and III, in one by the Collett-Edwards classification. Surgical techniques were similar to the first description by Lecompte except for the fact that distal pulmonary arterial stumps were approximated to ventriculotomy site without Lecompte maneuver in all cases. Also in all cases, mon-ocusps were placed using glutaraldehyde fixed autologous pericardial patch directly in right ventricular outflow tract. Three patients died postoperatively and the causes of death were myocardial failure, pulmonary hypertensive crisis and pulmonary complication due to progressive pulmonary vascualr obstructive disease respectively. The three survivors have been followed up for 6~10 months with good functional results.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.579-587
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• 2006

Background: Preoperative risk analysis for Fontan candidates is still less than optimal in that patients with apparently low risks may have poor surgical outcome; prolonged pleural drainage, protein losing enteropathy, pulmonary thromboembolism and death. We hypothesized that low pulmonary vascular compliance (PVC) is a risk factor for prolonged pleural effusion drainage after the Fontan operation. Material and Method: A retrospective review of 96 consecutive patients who underwent the Extracardiac Fontan procedures (median age: 3.9 years) was performed. Fontan risk score (FRS) was calculated from 12 categorized preoperative anatomic and physiologic variables. PVC $(mm^2/m^2{\cdot}mmHg)$ was defined as pulmonary artery index $(mm^2/m^2)$ divided by total pulmonary resistance $(W.U{\cdot}/m^2)$ and pulmonary blood flow $(L/min/m^2)$ based on the electrical circuit analogue of the pulmonary circulation. Chest tube indwelling time was log-transformed (log indwelling time, LIT) to fit normal distribution, and the relationship between preoperative predictors and LIT was analyzed by multiple linear regression. Result: Preoperative PVC, chest tube indwelling time and LIT ranged from 6 to 94.8 $mm^2/mmHg/m^2$ (median: 24.8), 3 to 268 days (median: 20 days), and 1.1 to 5.6 (mean: 2.9, standard deviation: 0.8), respectively. FRS, PVC, cardiopulmonary bypass time (CPB) and central venous pressure at postoperative 12 hours were correlated with LIT by univariable analyses. By multiple linear regression, PVC (p=0.0018) and CPB (p=0.0024) independently predicted LIT, explaining 21.7% of the variation. The regression equation was LIT=2.74-0.0158 PVC+0.00658 CPB. Conclusion: Low pulmonary vascular compliance is an important risk factor for prolonged pleural effusion drainage after the extracardiac Fontan procedure.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.691-695
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• 2007

Background: The introduction of central venous catheters in 1979 has aided the administration of chemotherapy to oncologic patients. We analyzed the clinical reviews and complications of totally implantable venous catheters in an effort to achieve optimal management. Material and Method: We retrospectively studied 100 cases with totally implantable venous catheter at our hospital and we report the results. Result: 100 totally implantable venous catheters were placed in the right subclavian vein in 74 cases (74%), the left subclavian vein in 21 cases, the right jugular vein in 3 cases, the left jugular vein in 1 case and the right femoral vein in 1 case. The immediate complications were 5 cases in malposition of the catheter and 5 cases of arterial puncture. The late complications were 1 case of subclavian vein thrombosis, which was treated with anticoagulation, and 2 cases of pinch-of syndrome. There were no other early or late complications. Conclusion: The low rate of complications in this study confirms the safety and convenience of using totally implantable venous catheter in patients undergoing prolonged chemotherapy. Yet because Infection, thrombosis, and catheter fracture are the most common long term complications of totally implantable venous catheters, early diagnosis and management of these problems can prevent severe complications.

• Journal of Chest Surgery
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• v.36 no.6
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• pp.384-390
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• 2003

Background: Since Ross and Sormeville first reported the use of aortic homograft valve for correction of pulmonary atresia in 1966, homograft valves are widely used in the repair of congenital anomalies as conduits between the pulmonary ventricle and pulmonary arteries. On the basis of these results, we have used it actively. In this report, we describe our experience with the use of cryopreserved valved homograft conduits for infants and children requiring right ventricle to pulmonary artery connection in various congenital cardiac anomalies. Material and Method: Between January, 1996 and December 2001, 27 infants or children with a median age of 16 months(range 9days to 18years) underwent repair of RVOTO using homograft valved conduit by two surgeons. We studied 22 patients who have been followed up at least more than one year. The diagnosis at operation included pulmonary atresia with ventricular septal defect (n=13), truncus arteriosus (n=3), TGA or corrected TGA with RVOTO (n=6). Homograft valved conduits varied in size from 15 to 26 mm (mean, 183.82 mm). The follow-up period ranged from 12 to 80.4 months (median, 48.4 months). Result: There was no re-operation due to graft failure itself. However, early progressive pulmonary homograft valve insufficiency developed in one patient, that was caused by dilatation secondary to the presence of residual distal pulmonary artery stenosis and hypoplasia after repair of pulmonary atresia with ventricular septal defect. This patient was required reoperation (conduit replacement). During follow-up period, there were significant pulmonary stenosis in one, and pulmonary regurgitation more than moderate degree in 3. And there were mild calcifications at distal anastomotic site in 2 patients. All the calcified homografts were aortic in origin. Conclusion: We observed that cryopreserved homograft conduits used in infant and children functioned satisfactorily in the pulmonic position at mid-term follow-up. To enhance the homograft function, ongoing investigation is required to re-establish the optimal strategy for the harvest, preservation and the use of it.

• Journal of Chest Surgery
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• v.35 no.1
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• pp.48-51
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• 2002

The conversion of failing Fontan circuit to total cavopulmonary connection(TCPC) is recommended as a therapeutic option in patients with late Fontan complications such as atrial arrhythmia, atrial enlargement, pulmonary venous obstruction, and ventricular dysfunction. Combined TCPC with extracardiac conduit and cryoablation of arrhythmia circuit is preferred for treatment of failing Fontan coulection with atrial lachyarrhythrnia. We report a case of conversion of atriopulmonary connection to extracardiac conduit Fontan and cryoablation of atrial arrhythmia circuit in a patient with tricuspid atresia, who also had ectopic atrial tachycardia, right atrial thrombi, pulmonary venous obstruction, and ventricular dysfunction. This patient and the parents were Jehovah's Witnesses; therefore, the patient underwent the procedure without blood transfusion.