Arrhythmias and thromboembolic complications after the extracardiac Fontan operation
Arrhythmias and thromboembolic complications after the extracardiac Fontan operation
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DOI：
10.1016/s0022-5223(98)70311-3
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发表时间：
1998-03-01
影响因子：
6
通讯作者：
Dubin, AM
中科院分区：
文献类型：
--
作者：
Shirai, LK;Rosenthal, DN;Dubin, AM
背景资料：Fontan手术后的晚期发病率和死亡率主要是由于房性心律失常、心室衰竭和血栓形成。心外Fontan手术避免了大量的心房操作和缝合线，理论上可以最大限度地减少这些事件的发生。我们研究了我们的经验，心外Fontan手术，特别注意血栓栓塞和心律失常，方法和结果：我们回顾性分析了所有16例患者的医疗和手术记录进行了心外Fontan手术1993年7月至1996年5月。15例（94%）患者术前处于窦性心律。术后即刻，7例（44%）出现心律失常，包括加速交界性心律和异位房性心律。未发生相关的血流动力学损害和早期死亡。术后随访3 ~ 34个月。8名患者（50%）在体表心电图上检测到心律失常，7名（44%）在24小时霍尔特监测研究中显示出窦房结功能障碍的证据。3例患者（19%）出现血栓。所有患者均无症状，超声心动图检查无导管阻塞迹象。结论：心外Fontan手术后，血流动力学显著的快速心律失常的发生率似乎减少。相当比例的患者有窦房结功能障碍的证据，表明存在其他手术或非手术因素导致这一发现。我们的血栓事件发生率与其他Fontan改良的既往报告相似。无限期维持这些患者的抗凝治疗似乎是一种合理的选择。
Background: Late morbidity and mortality after the Fontan operation are largely due to atrial arrhythmias, ventricular failure, and thrombus formation. The extracardiac Fontan procedure avoids extensive atrial manipulation and suture lines, theoretically minimizing the impetus for these events. We examined our experience with the extracardiac Fontan operation with particular attention to thromboembolism and arrhythmias, Methods and results: We retrospectively reviewed the medical and surgical records of all 16 patients who underwent an extracardiac Fontan operation between July 1993 and May 1996. Fifteen patients (94%) were in sinus rhythm before the operation. In the immediate postoperative period, seven (44%) had arrhythmias consisting of accelerated junctional rhythm and ectopic atrial rhythm. No associated hemodynamic compromise and no early deaths occurred. Patients were followed up for 3 to 34 months after the Fontan operation. Arrhythmias were detected in eight patients (50%) on surface electrocardiograms, and seven (44%) showed evidence of sinus node dysfunction on 24-hour Holter monitor studies. Thrombi were found in three patients (19%). All patients were asymptomatic, with no evidence of conduit obstruction by echocardiogram. Conclusions: The incidence of hemodynamically significant tachyarrhythmias appears to be reduced after the extracardiac Fontan operation. A significant percentage of patients have evidence of sinus node dysfunction, suggesting the presence of other surgical or nonsurgical factors responsible for this finding. Our incidence of thrombotic events is similar to previous reports with other Fontan modifications. It appears to be a reasonable option to maintain these patients on anticoagulation indefinitely.