HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Vladimir Alexi-Meskishvili Roland Hetzer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Alexi-Meskishvili, V. Articles by Hetzer, R. Search for Related Content PubMed PubMed Citation Articles by Alexi-Meskishvili, V. Articles by Hetzer, R.

Eur J Cardiothorac Surg 2000;18:690-695
© 2000 Elsevier Science NL

Optimal conduit size for extracardiac Fontan operation

^a Department of Cardiovascular and Thoracic Surgery, German Heart Institute (Deutsches Herzzentrum Berlin), Berlin, Germany
^b Department of Congenital Heart Disease, German Heart Institute (Deutsches Herzzentrum Berlin), Berlin, Germany

Received 24 February 2000; received in revised form 6 September 2000; accepted 25 September 2000.

Corresponding author. Tel.: +49-30-4593-2010; fax: +49-30-4593-110
e-mail: alexi{at}dhzb.de

Background: Lack of conduit growth potential and thrombogenicity are the main drawbacks of the extracardiac Fontan operation (ECFO). Optimal size of the conduit according to the patients age and inferior vena cava diameter has not been established. Objectives: We set out to ascertain whether the optimal dimensions of the conduit could be determined before an ECFO. Methods: Actual and expected age-related inferior vena cava diameters were compared with the extracardiac conduit diameter in 20 patients after ECFO. In 50 other pediatric and adult patients, the distance between intrapericardial part of the inferior vena cava and the undersurface of the right pulmonary artery (IVC–RPA) was measured. Cases of conduit thrombosis were analyzed. Results: The actual diameter of the inferior vena cava was variable and has a weak correlation with anthropmetric data and expected diameter (R=0.07–0.23, P=0.32–0.76). The IVC–RPA distance correlated with height (R=0.87, P=0.0001), but was also variable. At the age of 2–4 years and body weight 12–15 kg IVC diameter and IVC–RPA distance are equal to 60–80% of adult values. Conduit thrombosis developed in two patients with unfavorable Fontan hemodynamics and oversized conduits. Conclusions: Considering the inferior vena cava size, ECFO may be performed at the age of 2–3 years and at a body weight 12–15 kg, when a hemodynamically optimal almost adult sized conduit can be implanted. Optimization of the conduit is necessary on the basis of the actual inferior vena cava diameter and IVC–RPA distance. Anticoagulation postoperatively should be considered to prevent conduit thrombosis in patients with suboptimal Fontan circulation

Key Words: Extracardiac Fontan operation • Inferior vena cava

This article has been cited by other articles:

				K. Itatani, K. Miyaji, T. Tomoyasu, Y. Nakahata, K. Ohara, S. Takamoto, and M. Ishii Optimal conduit size of the extracardiac Fontan operation based on energy loss and flow stagnation. Ann. Thorac. Surg., August 1, 2009; 88(2): 565 - 572. [Abstract] [Full Text] [PDF]

				Y. Ochiai, Y. Imoto, M. Sakamoto, T. Kajiwara, A. Sese, M. Watanabe, T. Ohno, and K. Joo Mid-term follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure Eur. J. Cardiothorac. Surg., July 1, 2009; 36(1): 63 - 68. [Abstract] [Full Text] [PDF]

				S. Ovroutski, P. Ewert, V. Alexi-Meskishvili, K. Holscher, O. Miera, B. Peters, R. Hetzer, and F. Berger Absence of pulmonary artery growth after fontan operation and its possible impact on late outcome. Ann. Thorac. Surg., March 1, 2009; 87(3): 826 - 831. [Abstract] [Full Text] [PDF]

				A. L. Marsden, A. J. Bernstein, V. M. Reddy, S. C. Shadden, R. L. Spilker, F. P. Chan, C. A. Taylor, and J. A. Feinstein Evaluation of a novel Y-shaped extracardiac Fontan baffle using computational fluid dynamics. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 394 - 403.e2. [Abstract] [Full Text] [PDF]

				H. K. Park, Y. N. Youn, H.-S. Yang, B. W. Yoo, J. Y. Choi, and Y.-H. Park Results of an extracardiac pericardial-flap lateral tunnel Fontan operation Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 563 - 569. [Abstract] [Full Text] [PDF]

				R. KrishnankuttyRema, L. P. Dasi, K. Pekkan, K. Sundareswaran, M. Fogel, S. Sharma, K. Kanter, T. Spray, and A. P. Yoganathan Quantitative Analysis of Extracardiac Versus Intraatrial Fontan Anatomic Geometries Ann. Thorac. Surg., March 1, 2008; 85(3): 810 - 817. [Abstract] [Full Text] [PDF]

				T. Nakano, H. Kado, T. Tachibana, K. Hinokiyama, A. Shiose, M. Kajimoto, and Y. Ando Excellent Midterm Outcome of Extracardiac Conduit Total Cavopulmonary Connection: Results of 126 Cases Ann. Thorac. Surg., November 1, 2007; 84(5): 1619 - 1626. [Abstract] [Full Text] [PDF]

				C. Schreiber, J. Horer, M. Vogt, J. Cleuziou, Z. Prodan, and R. Lange Nonfenestrated Extracardiac Total Cavopulmonary Connection in 132 Consecutive Patients Ann. Thorac. Surg., September 1, 2007; 84(3): 894 - 899. [Abstract] [Full Text] [PDF]

				C. Lee, C.-H. Lee, S. W. Hwang, H. G. Lim, S.-J. Kim, J. Y. Lee, W.-S. Shim, and W.-H. Kim Midterm follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1008 - 1012. [Abstract] [Full Text] [PDF]

				E. Petrossian, V. M. Reddy, K. K. Collins, C. B. Culbertson, M. J. MacDonald, J. J. Lamberti, O. Reinhartz, R. D. Mainwaring, P. D. Francis, S. P. Malhotra, et al. The extracardiac conduit Fontan operation using minimal approach extracorporeal circulation: early and midterm outcomes. J. Thorac. Cardiovasc. Surg., November 1, 2006; 132(5): 1054 - 1063. [Abstract] [Full Text] [PDF]

				J. H. Nurnberg, S. Ovroutski, V. Alexi-Meskishvili, P. Ewert, R. Hetzer, and Peter. E. Lange New Onset Arrhythmias After the Extracardiac Conduit Fontan Operation Compared With the Intraatrial Lateral Tunnel Procedure: Early and Midterm Results Ann. Thorac. Surg., December 1, 2004; 78(6): 1979 - 1988. [Abstract] [Full Text] [PDF]

				S. Ovroutski, P. Ewert, V. Alexi-Meskishvili, B. Stiller, J.-H. Nurnberg, H. Abdul-Khaliq, R. Hetzer, and P. E. Lange Comparison of somatic development and status of conduit after extracardiac Fontan operation in young and older children Eur. J. Cardiothorac. Surg., December 1, 2004; 26(6): 1073 - 1079. [Abstract] [Full Text] [PDF]

				T. Nakano, H. Kado, S. Ishikawa, Y. Shiokawa, H. Ushinohama, K. Sagawa, N. Fusazaki, Y. Nishimura, Y. Tanoue, T. Nakamura, et al. Midterm surgical results of total cavopulmonary connection: clinical advantages of the extracardiac conduit method J. Thorac. Cardiovasc. Surg., March 1, 2004; 127(3): 730 - 737. [Abstract] [Full Text] [PDF]

				Y. Isomatsu, T. Shin'oka, G. Matsumura, N. Hibino, T. Konuma, M. Nagatsu, and H. Kurosawa Extracardiac total cavopulmonary connection using a tissue-engineered graft J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1958 - 1962. [Abstract] [Full Text] [PDF]

				S. Ovroutski, V. Alexi-Meskishvili, P. Ewert, J.-H. Nurnberg, R. Hetzer, and P.E. Lange Early and medium-term results after modified Fontan operation in adults Eur. J. Cardiothorac. Surg., March 1, 2003; 23(3): 311 - 316. [Abstract] [Full Text] [PDF]

				A. T. Yetman, J. Drummond-Webb, W. P. Fiser, M. L. Schmitz, M. Imamura, S. Ullah, R. J. Gunselman, C. W. Chipman, C. E. Johnson, and S. H. Van Devanter The extracardiac Fontan procedure without cardiopulmonary bypass: technique and intermediate-term results Ann. Thorac. Surg., October 1, 2002; 74(4): S1416 - 1421. [Abstract] [Full Text] [PDF]