tıklayınız - Türk Pediatrik Kardiyoloji ve Kalp Cerrahisi Derneği

it is more difficult to place a fenestration. Although use of an extracardiac conduit
allows cardiopulmonary bypass to be avoided there is a risk that the anastomosis will
not be as widely patent as can be achieved with cardiopulmonary bypass.
Intra/extracardiac conduit Fontan
A modification of the extracardiac conduit is the extra/intracardiac conduit. Today the
intra/extracardiac conduit is preferred over the lateral tunnel. This procedure combines
the advantages of the extracardiac conduit with ease of fenestration. Technical details
will be presented.
Should the fenestration be closed: If so, when?
There is ongoing controversy as to whether the fenestration should be closed in
the catheterization laboratory within a year or so of the Fontan procedure. Current
practice allows for temporary balloon occlusion with measurement of the change in
cardiac output and increase in right atrial pressure. Currently a fall in cardiac output
of up to 25% is tolerated.
Need for Multi Institutional Trial
There are many ongoing controversies regarding all stages of the management of
hypoplastic left heart syndrome. In the future trials must be undertaken to answer
these questions. These trials should not only assess late survival and late quality of
life but most importantly should include exercise studies with assessment of maximal
oxygen consumption.
References
1. Chang AC, Hanley FL, Wernovsky G, et al. Early bidirectional cavopulmonary shunt
in young infants. Postoperative course and early results. Circulation. 1993;88(5 Pt
2):II149-58.
2. Mainwaring RD, Lamberti JJ, Uzark K, Spicker RL, Cocalis MW, Moore JW. Effect of
accessory pulmonary blood flow on survival after the bidirectional Glenn procedure.
Circulation. 1999;100(19 Suppl):II151-6.
3.Douville EC, Sade RM, Fyfe DA. Hemi-Fontan operation in surgery for single
ventricle: a preliminary report. Ann Thorac Surg. 1991;51:893-9.
4. Jonas RA, Castaneda AR. Modified Fontan procedure: atrial baffle and systemic
venous to pulmonary artery anastomotic techniques. J Card Surg. 1988;3:91-6.
5.Marcelletti C, Corno A, Giannico S, Marino B. Inferior vena cava-pulmonary artery
extracardiac conduit. A new form of right heart bypass. J Thorac Cardiovasc Surg.
1990;100:228-32.
65