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Review
. 2012 Jul;98(14):1098-104.
doi: 10.1136/heartjnl-2011-301133.

Management of the failing Fontan circulation

Barbara J Deal  1 , Marshall L Jacobs
Affiliations
Review

Management of the failing Fontan circulation

Barbara J Deal et al. Heart. 2012 Jul.
No abstract available

PubMed Disclaimer

Conflict of interest statement

Competing interests: In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. The authors have no competing interests.

Figures

Figure 1
Figure 1
MRI of marked atrial dilatation with impingement on pulmonary venous return in a patient with an atriopulmonary Fontan anastomosis for tricuspid atresia. Right atrium measures 7×7.5 cm. Image courtesy of Cynthia K Rigsby, Children's Memorial Hospital, Chicago, Illinois, USA.
Figure 2
Figure 2
Management of atrial arrhythmias in Fontan patients. PLE, protein-losing enteropathy.
Figure 3
Figure 3
Surgical modifications of atrial maze procedure in complex anatomy. Solid black lines indicate sites of cryoablation. avn, atrioventricular node; CS, coronary sinus; FO, foramen ovale; HV, hepatic vein; IVC, inferior vena cava; LAA, left atrial appendage; LSVC, left superior vena cava; MV, mitral valve; PV, pulmonic vein; RAA, right atrial appendage; RSVC, right superior vena cava; TAPVR, total anomalous pulmonary venous return; TV, tricuspid valve. Reprinted with permission from Mavroudis C, Deal BJ, Backer CL, Tsao S. Arrhythmia surgery in patients with and without congenital heart disease. Ann Thorac Surg 2008;86:857–68.
See this image and copyright information in PMC

References

    1. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax 1971;26:240–8 - PMC - PubMed

    2. The surgery as described is obsolete, but worth reading for the comments on the longevity of homografts, perioperative management, and prediction of arrhythmias.

    1. Hosein RB, Clarke AJ, McGuirk SP, et al. Factors influencing early and late outcome following the Fontan procedure in the current era. The 'Two Commandments'? Eur J Cardiothorac Surg 2007;31:344–53 - PubMed

    2. An in-depth analysis of the key haemodynamic factors contributing to long term survival in a large series of Fontan patients.

    1. d'Udekem Y, Iyengar AJ, Cochrane AD, et al. The Fontan procedure: contemporary techniques have improved long-term outcomes. Circulation 2007;116(11 Suppl):I157–64 - PubMed

    2. An excellent comparison of the long term outcomes of patients undergoing the three major types of Fontan modifications.

    1. Cohen MS, Zak V, Atz AM, et al. Anthropometric measures after Fontan procedure: implications for suboptimal functional outcome. Am Heart J 2010;160:1092–8 - PMC - PubMed
    1. Fernandes SM, McElhinney DB, Khairy P, et al. Serial cardiopulmonary exercise testing in patients with previous Fontan surgery. Pediatr Cardiol 2010;31:175–80 - PMC - PubMed