TITLE:
Hemodynamic Changes and Clinical Outcomes after the Intra/Extracardiac Fenestrated Fontan Procedure
AUTHORS:
Naveen Menon, Chihyang Lin, Cesar I. Mesia, Achintya Moulick, Randy Stevens, Vicki Mahan
KEYWORDS:
Fontan, Functionally Univentricular Heart, Circulatory Hemodynamics, Hypoplastic Left Heart Syndrome, Congenital Heart Disease (CHD)
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.8 No.2,
February
12,
2018
ABSTRACT: Background: The primary concern of the Fontan procedure has been atrial arrhythmias,
but little attention has been given to hemodynamic changes. This study’s
purpose was to examine the hemodynamics and arrhythmias of the Intra/extracardiac fenestrated Fontan, and
determine any advantages/disadvantages of this newer Fontan procedure. Methods: Patients undergoing the intra/ extracardiac
fenestrated Fontan procedure at this institute between December 2009 and June
2017 were included in this retrospective evaluation of preoperative and postoperative hemodynamics during
cardiac catheterization. End Diastolic Pressure (EDP), Pulmonary Artery
Pressure (PAP), Left Atrial Pressure (LAP), and Transpulmonary Gradient (TPG)
were the hemodynamic markers of interest. Occurrence of arrhythmias was also examined preoperatively, less than 2 weeks postoperatively,
and greater than 2 weeks postoperatively. Morbidities and mortalities were also
evaluated. Results: Fourteen
patients underwent the procedure between December 2009 and June 2017.
Preoperative data was available in all of these patients. Postoperative data
was partially incomplete for atrial arrhythmias and hemodynamic data. EDP rose
from 9.29 ± 3.50 mmHg to 10.33 ± 3.12 mmHg. PAP rose from 12.57 ± 2.50 mmHg to
14.27 mmHg. TPG dropped from 5.00 ± 2.29 mmHg to 3.25 ± 1.67 mmHg. LAP rose
from 7.57 ± 2.87 mmHg to 10.30 ± 1.95 mmHg. Atrioventricular valve (AVV)
regurgitation remained the same pre and postoperatively. 8 of 13 patients
developed arrhythmias at less than 2 weeks postoperatively, and 5 of 12 patients developed arrhythmias at greater than
2 weeks postoperatively. There were no morbidities or mortalities. Conclusions: We
found a statistically significant change in EDP, PAP, LAP, and TPG levels. It
is unclear whether this is an advantage or disadvantage. The significance of these changes is unclear in this small population of patients. Further
evaluation of hemodynamics, arrhythmias,
morbidities and mortalities associated with the intra/extracardiac Fontan procedure is needed.