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J Thorac Cardiovasc Surg 2007;133:1302
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Discussion

Dr Constantine Mavroudis (Chicago, Ill). Dr Koh, you have performed a retrospective study in a relatively small group of patients in whom you noted time-related changes of P-wave characteristics that result in a stepwise degeneration of coordinated atrial activity leading to ectopic atrial arrhythmias, atrial tachycardia, and eventually atrial fibrillation in APC Fontan patients with tricuspid atresia. This is a relatively small group of patients with one diagnosis.

You developed a thesis that atriopulmonary to total cavopulmonary artery extracardiac Fontan conversion should be performed on the basis of P-wave abnormalities even before atrial tachycardia and symptoms cause complications in existing patients with a stable APC Fontan.

The idea that all APC Fontan patients regardless of symptoms or abnormal hemodynamic findings should be converted to total cavopulmonary extracardiac connections has . . . [Full Text of this Article]

Related Article

Optimal timing of the Fontan conversion: Change in the P-wave characteristics precedes the onset of atrial tachyarrhythmias in patients with atriopulmonary connection

Masahiro Koh, Toshikatsu Yagihara, Hideki Uemura, Koji Kagisaki, Ikuo Hagino, Toru Ishizaka, and Soichiro Kitamura
J. Thorac. Cardiovasc. Surg. 2007 133: 1295-1302. [Abstract] [Full Text] [PDF]