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Right arrow Congenital - cyanotic

J Thorac Cardiovasc Surg 2007;133:1371-1373
© 2007 The American Association for Thoracic Surgery

Brief Communication

Reversal of increased pulmonary arterial pressure associated with systemic venous collaterals after tonsillectomy in a Fontan candidate after the Glenn procedure: Impact of obstructive sleep apnea on Fontan circulation

Hirofumi Sawada, MDa, Yoshihide Mitani, MD, PhDa,*, Hiroyuki Ohashi, MDa, Hidetoshi Hayakawa, MD, PhDa, Yukiko Ikeyama, MDa, Shin Takabayashi, MD, PhDb, Hideto Shimpo, MD, PhDb, Kazuo Maruyama, MD, PhDc, Yoshihiro Komada, MD, PhDa

a Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Mie, Japan
b Departments of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
c Department of Anesthesiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.

Received for publication December 27, 2006; accepted for publication January 2, 2007.

* Address for reprints: Yoshihide Mitani, MD, PhD, Department of Pediatrics, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie Pref, 514-8507, Japan. (Email: ymitani@clin.medic.mie-u.ac.jp).

The first 20% of the full text of this article appears below.

An increase in pulmonary artery (PA) pressure, associated with the development of systemic venous collaterals, is one of the greatest risks for candidates for the Fontan procedure after the Glenn procedure.1,2Go Simple coil embolization for such collaterals may not be sufficient, inducing other collaterals accompanied by persistent high PA pressure with poor outcomes. Mild pulmonary hypertension is a common complication associated with obstructive sleep apnea (OSA).3Go However, the effects of OSA on pulmonary circulation in Fontan candidates are unknown. We report a patient with a successful Fontan completion in whom high PA pressure associated with venous collaterals after the Glenn procedure was reversed after a tonsillectomy for OSA after coil embolization.

Clinical Summary

A 3-year-old boy with pulmonary atresia with an intact ventricular septum presented with progressive cyanosis. The boy had undergone a right modified Blalock–Taussig shunting procedure in the neonatal period and a bidirectional cavopulmonary anastomosis at the age of 6 months. His parents had noticed his dysphagia and nocturnal apnea accompanied by snoring since he was 1 year and 6 months old. Cyanosis and . . . [Full Text of this Article]






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