[Complex progressive palliation for univentricular circulation]

Abstract

The type of palliative procedures (PP) for complex univentricular circulation (UC) changed significantly during the 80ies. Between 07/86 and 02/91 77 patients (pts) presented with UC to eventually undergo a modified Fontan-Kreutzer-type-operation (MFKTO). 33 pts had been previously palliated, 22 of whom were accepted for MFKTO as well as an additional 9 not palliated pts (group A: 31 pts; 20 PP). 11 previously palliated pts and 35 new pts required new palliations (group B: 46 pts; 89 PP), 34 of which resulted in 13 MFKTO. Prerequisites to be met for MFKTO are: undistorted PA-anatomy; absence of subaortic stenosis (SAS); Qp greater than 2.5 l/min/m2; PAP less than 20 mm Hg; Rp less than 3 Wood Units. All earlier PP in group A (31 BTS, 3 PAB, 2 PA-valvotomy/dil.) merely prolonged survival by only adjusting Qp. In group B PP comprise reconstruction of pulmonary arteries, aortic arch and isthmus as well as bypass or resection of SAS or atrial septectomy. Mortality for complex PP (group B) was 32.5% (15/46). 9 of these pts were neonates, 7 after modified Norwood procedures. In an attempt to plan a MFKTO for all pts presenting with UC (group B), complex PP was necessary. The high mortality is due to lesions in pts who would not have survived if only closed PP were applied.