The Fontan procedure in adults
The Fontan procedure in adults
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DOI：
10.1016/s0003-4975(96)01256-8
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发表时间：
1997-04-01
影响因子：
4.6
通讯作者：
Perloff, JK
中科院分区：
文献类型：
--
作者：
Gates, RN;Laks, H;Perloff, JK
背景。回顾性临床研究记录了接受Fontan手术的成年患者的过程。1982年至1994年间，21名年龄在18至40岁（平均年龄27±7岁）的成年人接受了Fontan手术。解剖诊断为三尖瓣闭锁9例，左心室双入口4例，单心室各种类型8例。4例为右心房-右心室连接，13例为右心房-肺动脉连接，4例为外侧隧道方坦。这4人中有3人有可调节的房间隔缺损。术前评估的危险因素为左室舒张末压大于10mm Hg，射血分数小于0.45，平均肺动脉压高于15mm Hg，经肺梯度大于10mm Hg，肺动脉异常，房室瓣膜返流。术前平均风险评分为1.6 +/- 1.1。纽约心脏协会平均分级为2.6 +/- 0.5。手术死亡率为5%（1/21）。6例（30%）有严重并发症，4例为长期积液。1例患者失访；其余20人的平均随访时间为7.4±3.8年。在随访中，纽约心脏协会的平均分级为1.7±0.5。92岁晚期死亡1例（5%），可能是室性心律失常所致。3例（16%）患者需要再次手术并存活。随访期间，7例（37%）发生房性心律失常需要药物治疗，2例因室性心律失常接受治疗。这些结果表明，适当选择的成年人可以接受Fontan手术，发病率和死亡率低。然而，迟发性心律失常，需要再手术和心室功能下降是严重的问题，需要仔细随访。(C) 1997年由胸外科学会出版。
Background. A retrospective clinical study was performed to document the course of adult patients undergoing the Fontan procedure.Methods. Between 1982 and 1994, 21 adults aged 18 to 40 years (mean age, 27 +/- 7 years) underwent a Fontan procedure. Anatomic diagnosis was tricuspid atresia in 9, double-inlet left ventricle in 4, and various single ventricles in 8. Four underwent a right atria-right ventricle connection, 13 had a right atria-pulmonary artery connection, and 4 had a lateral-tunnel Fontan. Three of these 4 had a snare-adjustable atrial septal defect. Preoperative risk factors assessed were left ventricular end-diastolic pressure greater than 10 mm Hg, ejection fraction lower than 0.45, mean pulmonary artery pressure higher than 15 mm Hg, transpulmonary gradient greater than 10 mm Hg, pulmonary artery abnormalities, and atrioventricular valve regurgitation. Mean preoperative risk score was 1.6 +/- 1.1. Mean New York Heart Association class was 2.6 +/- 0.5.Results. The operative mortality rate was 5% (1/21). Six patients (30%) had a major complication, four being prolonged effusions. One patient was lost to follow-up; the remaining 20 have been followed for a mean of 7.4 +/- 3.8 years. At follow-up, mean New York Heart Association class was 1.7 +/- 0.5. There has been one late death (5%) at 92/3 years, which was probably due to ventricular arrhythmia. Three patients (16%) have required and survived reoperation. During follow-up, 7 patients (37%) have had development of atrial arrhythmias requiring medication, and 2 have been treated for ventricular arrhythmias.Conclusions. These results indicate that properly selected adults can undergo the Fontan procedure with low morbidity and mortality. However, late-developing arrhythmias, need for reoperation, and decreasing ventricular function are serious problems that mandate careful follow-up. (C) 1997 by The Society of Thoracic Surgeons.