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J Thorac Cardiovasc Surg 1998;115:547-556
© 1998 Mosby, Inc.
SURGERY FOR CONGENITAL HEART DISEASE |
From the Divisions of Cardiovascular-Thoracic Surgery and Cardiology, The Children's Memorial Hospital, and the Departments of Surgery and Pediatrics, Northwestern University Medical School, Chicago, Ill.
Presented at the Second World Congress of Pediatric Cardiology and Cardiac Surgery, Honolulu, Hawaii, May 11-15, 1997.
Received for publication June 13, 1997; revisions requested July 30, 1997; revisions received Sept. 8, 1997; accepted for publication Sept. 8, 1997. Address for reprints: Constantine Mavroudis, MD, Division of Cardiovascular-Thoracic Surgery, Mail Code 22, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614.
Objectives: We review our surgical experience patients with atriopulmonary Fontan operations who had obstructive or arrhythmia indications for conversion to total cavopulmonary artery connections, arrhythmia circuit cryoablation, and placement of atrial antitachycardia pacemaker.
Methods: Fourteen patients (mean age 14 ± 4 years) had conversion to total cavopulmonary artery connection 8 ± 3 years after the original atriopulmonary Fontan operation primarily for atrial arrhythmias in 11, obstructive lesions in 2, and bradycardia with cyanosis in 1. Arrhythmia circuit cryoablation was performed on 11 patients and 10 had atrial antitachycardia pacemakers. Preoperative functional New York Heart Association class was IV in 9, III in 4, and II in 1.
Results: One patient had brain death (7%) presumably caused by resternotomy complications despite an excellent hemodynamic result. Another required reoperation for a maldeployed clamshell device after attempted fenestration closure. Average length of stay was 10 ± 3 days; chest tubes were removed on day 7 ± 3. There were no long-term deaths (mean follow-up 1.7 years, range 5 months to 5 years). Postoperative arrhythmias occurred in five patients, three of whom had successful termination by antitachycardia pacemaker and two who had pharmacologic control of their respective junctional ectopic and slow atrial tachycardia. All patients have improved to New York Heart Association class I or II.
Conclusions: Total cavopulmonary artery conversion in association with arrhythmia circuit cryoablation and atrial antitachycardia pacemaker placement can be accomplished with low morbidity and mortality, oftentimes resulting in dramatic increases in functional class and control of life-threatening arrhythmias.
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