EJCTS Click here for details of sales representative
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Eur J Cardiothorac Surg 2008;33:951. doi:10.1016/j.ejcts.2008.01.031
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Vladimir Alexi-Meskishvili
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ovroutski, S.
Right arrow Articles by Alexi-Meskishvili, V.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ovroutski, S.
Right arrow Articles by Alexi-Meskishvili, V.
Related Collections
Right arrow Congenital - cyanotic

Letters to the Editor

Does the Nakata index predict outcome after Fontan operation?

Stanislav Ovroutski*, Vladimir Alexi-Meskishvili

Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13533 Berlin, Germany

Received 24 December 2007; accepted 21 January 2008.

* Corresponding author. Tel.: +49 30 4593 2800; fax: +49 30 4593 2900. (Email: ovroutski{at}dhzb.de).

Key Words: Fontan operation • Pulmonary artery indices

We read with interest the article by Adachi et al. ‘Preoperative small pulmonary artery did not affect the midterm results of Fontan operation’ [1].

One of the main messages of the article is that Fontan operation can be successfully performed in patients with a preoperative PA index smaller than 250 mm2/m2. Further, the authors note that decreased pulmonary artery index postoperatively does not restrict functional efficacy of the Fontan circulation.

From our point of view the predictive value Nakata index is less informative than the lower lobe index (LLI) which was introduced to optimize preoperative selection of Fontan candidates [2–4]. We use LLI as being more predictive to evaluate adequacy of the pulmonary vascular tree, given that central pulmonary arteries used for calculation of Nakata index can be enlarged before or during a Fontan operation [4].

The lowest Nakata index that precludes a successful Fontan operation is not known [5].

The authors have suggested that PA size at the hilum could be a good representative of the whole PA vascular bed. In the presence of low Nakata index, the normal LLI would automatically classify all these patients to be no longer in a risk category [4]. We observed in our series that the total lower lobe index is more informative than the Nakata index for the selection of candidates for a Fontan operation. In 13 patients (22%) with a low Nakata index (under 200 mm2/m2, lowest 125 mm2/m2), the presence of a normal total lower lobe index (>90 mm2/m2) enabled us to successfully perform ECFO combined with enlargement of the main pulmonary arteries in six of them [2].

Based on our experience, we believe that measurement of the lower lobe index is an important adjunct for the evaluation of candidates for Fontan operation.

References

  1. Adachi I, Yagihara T, Kagisaki K, Hagino I, Ishizaka T, Kobayashi J, Kitamura S, Uemura H. Preoperative small pulmonary artery did not affect the midterm results of Fontan operation. Eur J Cardiothorac Surg 2007;32:156-162.[Abstract/Free Full Text]
  2. Alexi-Meskishvili V, Ovroutski S, Ewert P, Nurnberg JH, Stiller B, Abdul-Khaliq H, Hetzer R, Lange PE. Mid-term follow-up after extracardiac Fontan operation. Thorac Cardiovasc Surg 2004;52:218-224.[CrossRef][Medline]
  3. Nakata S, Imai Y, Takanashi Y, Kurosawa H, Tezuka K, Nakazawa M, Ando M, Takao A. A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 1984;88:610-619.[Abstract]
  4. Reddy VM, McElhinney DB, Moore P, Petrossian E, Hanley FL. Pulmonary artery growth after bidirectional cavopulmonary shunt: is there a cause for concern?. J Thorac Cardiovasc Surg 1996;112:1180-1190.[Abstract/Free Full Text]
  5. Bridges ND, Farrell Jr. PE, Pigott JDd, Norwood WI, Chin AJ. Pulmonary artery index. A nonpredictor of operative survival in patients undergoing modified Fontan repair. Circulation 1989;80:I216-I221.[Medline]



This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
S. I. Sersar and A. A. Jamjoom
Contegra and extracardiac Fontan.
J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1393 - 1393.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
I. Adachi, H. Uemura, and T. Yagihara
Reply to Ovroutski and Alexi-Meskishvili
Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 951 - 952.
[Full Text] [PDF]

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

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS