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Biomedical subjects

F Fontan

Publications and source records attributed to F Fontan.

At least 19 recordsLinked to original sources
PubMed1992

Value of transesophageal echocardiography combined with computed tomography for assessing repaired type A aortic dissection.

Thirty-two patients with repaired type A aortic dissection were examined by transthoracic echocardiography (TTE) (n = 32), transesophageal echocardiography (TEE) (n = 30), computed tomography (CT) (n = 29), or a combination of all 3, to assess course and complications as a function of the surgical procedure. The mean follow-up period was 55.7 months (range 3 to 132). Surgery consisted of a replacement of the ascending aorta in 25 patients (group 1) with extension to the transverse aorta in 7 (group 2). The transverse diameter of the aorta, the persistence of the false lumen, thrombus formation and flow dynamics in the false lumen were evaluated by TEE. Ten patients (31%) had a dilation in the initial ascending aorta (sinus of Valsalva aneurysm in 6 patients, and a false aneurysm in the other 4). Three of 4 patients with a proximal pseudoaneurysm underwent operation after TEE and CT evaluation. In the descending thoracic aorta, there was good agreement between TEE and CT scan determinations of transverse vessel diameter. Persistence of flow within the false lumen was significantly more frequent in patients with a dilated aorta (p < 0.05), whereas thrombosis was seen more often and false lumen less often in patients with nondilated aorta. No significant differences in vessel status or outcome were observed between the 2 groups, although this may have been due to the small size of group 2. TEE is thus a well-tolerated method for postoperative follow-up of type A aortic dissection whatever the type of surgery. For the upper ascending aorta, CT provided sufficient data.

Adult↗
PubMed1992

Modifying myocardial management in cardiac surgery: a randomized trial.

Among the 160 patients randomly assigned to one of eight protocols of myocardial management, all of which included controlled aortic root reperfusion, no important differences were found between protocols as to the prevalence of death (0 instances), use of an intra-aortic balloon pump (no instances), use of catecholamines, elaboration of CK-MB isoenzymes, new Q-waves, abnormal wall motion scores, or postoperative atrial fibrillation. Ventricular defibrillation was required more often in patients in the protocol with noncardioplegic blood reperfusate. Cardiac index was highest in the operating room in the group receiving hyperkalemic cold cardioplegia and initial hyperkalemic reperfusion. The reperfusion flow at the controlled pressures had initially a low flow rate (pressure 30 mmHg for 2 min; thereafter 50 mmHg), which increased to reach a peak flow rate at about 3 min after the start of reperfusion, followed by a declining flow rate reflecting changes in coronary resistance. Comparison of the overall randomly assigned group with a historical control group of 100 patients operated upon prior to the randomized trial showed no differences except for a higher rate of postoperative atrial fibrillation (25%) in the historical control group than in the randomized protocols with initial cardioplegic reperfusion (14%). The controlled reperfusion technique was found to be easy to use and is now used routinely.

Aged↗
PubMed1992

A new biodegradable elastin-fibrin material; its use in urological, digestive and cardiovascular surgery.

A new original artificial connective matrix mainly made of elastin and fibrin-like product is used to reinforce damaged tissues and to close and restore a loss of substance in several domains of surgery: all sites in the digestive system and urinary tract; besides, it can substitute for the pericardium in iterative heart operations. In all cases, the original tissue is restored ad integrum while the biodegradable material disappears completely, without any complications.

Animals↗
PubMed1992

Mechanical cardiac valve thrombosis. Is fibrinolysis justified?

BACKGROUND: Thrombosis is a serious complication of heart valve replacement, and management is often difficult. In recent years, thrombolytic therapy has been used as the primary technique by some investigators. METHODS AND RESULTS: Sixty-four consecutive patients presenting with 75 instances of prosthetic heart valve thrombosis (41 mitral, 33 aortic, one tricuspid) were treated with fibrinolytic agents. Obstructed prosthetic valves comprised 39 tilting disc and 36 bileaflet valves. The time interval between valve replacement and obstruction ranged from 15 days to 192 months (mean, 38 months). Fibrinolytic agents used were streptokinase (42 patients), urokinase (27 patients), or recombinant tissue-type plasminogen activator (six patients). Immediate results of fibrinolytic treatment were 1) full success after one or several consecutive fibrinolytic regimens in 55 cases (73%), 2) incomplete improvement in two cases, and 3) failure in 18 cases, leading to an emergency surgery in nine cases. Nine patients died (four strokes, four cardiac arrests, one hemorrhage). Only one severe hemorrhagic complication was observed, but 11 cases of embolism occurred during fibrinolytic treatment (14.6%) (four major cerebral embolisms with death). The immediate efficacy was better for thrombosed aortic prosthesis than with the mitral prosthesis (85% versus 63%). CONCLUSIONS: Fibrinolytic treatment appears to be an attractive nonsurgical alternative for prosthetic heart valve thrombosis, but because of the risk of cerebral embolism, its use should be reserved for tricuspid valve thrombosis or critically ill patients with mitral or aortic valve thrombosis. The use of a fibrinolytic agent in cases of small, nonobstructive paravalvular thrombosis demonstrated with transesophageal echocardiography needs further studies.

Aortic Valve↗
PubMed1992

[Cardiac compression by a large thymic cyst. Apropos of a case, review of the literature].

Thymic cysts are rare and almost always asymptomatic. The authors report the case of a 45 year old woman with a thymic cyst diagnosed after recurrent right sided heart failure resulting in signs suggestive of adiastole, regressing after "pleural" (mainly cystic) aspiration and diuretic therapy without any morphological or functional changes on Doppler echocardiography. This report concerns a rare tumour, with an exceptional volume (2 litres) extending down the cardiac borders and causing cardiac compression. It illustrates the diagnostic difficulty of a pathology with an unusual clinical presentation, despite complementary investigations including CT scan and MRI, very sensitive in this type of problem. A complete cure was obtained by total surgical ablation.

Adult↗
PubMed1991

Surgery of post-infarction ventricular septal defect: risk factors for hospital death and long-term results.

From December 1971 to December 1989, 62 patients (pts) 42 males, 20 females, mean age 66 years (yr) 6 months (mth) (range 52-80) were operated upon for post-infarction ventricular septal defect (VSD), (anterior 34, inferior 28). Eight pts (13%), group (G) 1 presented with cardiogenic shock, 19 pts (30.5%), G2 with severe congestive heart failure (CHF); 31 pts (50%), G3 were stable with mild CHF and 4 pts (6.5%), G4 without CHF. Preoperative intra-aortic balloon pumping (IABP) was used in 49 pts (79%). One transplanted pt was excluded from this study. The VSD was closed from 1 day (d) to 5 mth (mean 13 d) after its occurrence. Hospital death (HD) occurred in 23 pts (37.7% +/- 6%). Of 44 incremental risk factors (RF) for HD studied, the preoperative status (PS) was the most significant (P less than 0.01). G1: 87% +/- 12%, G2: 42% +/- 12%, G3: 25.8% +/- 8%, G4: 0%. [table: see text] Non-survivors had a shorter mean delay between VSD occurrence and surgery than survivors: 5.6 +/- 3.7 d vs 18.2 +/- 30 d (P less than 0.05), but this delay was correlated to PS. The follow-up of the 38 early survivors ranges from 2 mth to 14 yr (mean 3 yr, 11 mth); 11 pts died between 45 d and 14 yr. No RF was identified for premature late death. HD included, the actuarial survival rate at 1, 5, 10 yr is: 57% (+/- 7%), 44% (+/- 8%), 30% (+/- 10%), respectively.

Aged↗
PubMed1991

[Brucella endocarditis of bicuspid aortic valve. Surgical treatment with successful result].

The authors report a case of Brucella Melitensis endocarditis of a bicuspid aortic valve which caused rapid progression of the hemodynamic signs of aortic stenosis, and was associated with a para-aortic abscess and a pericardial effusion. Surgery resulted in correction of the hemodynamic abnormalities and cured the infection: the results were sustained 10 months after operation. This case illustrates the precision of the Doppler, echocardiographic diagnosis of the lesions, which was confirmed at surgery so that potentially dangerous cardiac catheterisation could be avoided.

Adult↗
PubMed1990

Special problems in Fontan-type operations for complex cardiac lesions.

Four patients with complex cardiac lesions, who underwent successfully a Fontan type of operation are presented, each case representing a particular problem in surgical management. The first exhibited displacement of a trileaflet straddling and overriding left atrioventricular valve in addition to tricuspid atresia, while the second one had unilateral lung perfusion. In the third case, a stenosis had developed near the origin of the right pulmonary artery, and pulmonary vascular resistance could not be determined prior to the definite palliation procedure, whereas the fourth patient presented with stenosis of the left atrioventricular valve. Surgery was planned after detailed evaluation of the morphologic and hemodynamic features by means of echocardiography and cardiac catheterization. Our results illustrate the common tendency to extend the limits for modified Fontan procedures, which also includes revision of the original criteria for selection.

Cardiac Catheterization↗
PubMed1990

Therapeutic use of right atrial pressures early after the Fontan operation.

In 334 patients undergoing the Fontan operation, the right atrial pressure was 16 +/- 36 mm Hg (mean value +/- SD) 3 h postoperatively, and was on average higher in those who died or had a takedown of the operation than in those who did not (P = 0.0001). Twenty-four hours after operation, the right atrial pressure was 18 +/- 5.5 mm Hg, was higher in those who died or had a takedown than in those who did not (P less than 0.0001); and in those who died or had takedown it was 23.5 +/- 1.66 mm Hg and higher than at 3 h postoperatively (18.7 +/- 0.52). The left atrial pressure 3 h postoperatively was 9 +/- 3.6 mm Hg, and on average was higher in the patients who died or had a Fontan takedown than in those who did not. The continuous relation between right atrial pressure and the probability of death or takedown during the first 24 postoperative hours was such as to recommend consideration of takedown whenever the right atrial pressure reaches 22 mm Hg, and when higher, the recommendation is made with greater urgency.

Adolescent↗
PubMed1990

Outcome after a "perfect" Fontan operation.

A study was undertaken to determine the early and long-term outcomes dictated by the Fontan state per se (a state in which the force driving pulmonary blood flow is solely or largely a residue, in the systemic venous pressure, of the main ventricular chamber's contractile force) and the transition (by surgery) to it from the state of congenital heart disease under optimal conditions (after a "perfect" Fontan operation). The primary study design used a solution of a multivariate risk factor equation for death, by which survival rate under optimal conditions was predicted to be 92%, 89%, 88%, 86%, 81%, and 73% at 1 month, 6 months, and 1, 5, 10, and 15 years, respectively, after the Fontan operation. The hazard function (instantaneous risk of death at each moment in time after the operation) had an early rapidly declining phase of hazard that at about 6 months began to give way to a late hazard phase, which was rising by about 6 years after surgery. A secondary study design, using the theory of competing risks, yielded survival and hazard function information very similar to that of the primary study design. The functional capacity of the patients as expressed by New York Heart Association class was less, the longer the period of follow-up. No risk factors (other than older age at time of surgery) were found for the late decline in survival or the decline in functional status. The inference is that the premature decline in survival and functional status and the late rise in hazard function are from the Fontan state per se and that the Fontan operation is, therefore, palliative but not curative.

Adolescent↗
PubMed1989

Prevalence of reoperation for pathway obstruction after Fontan operation.

Among 334 patients undergoing the Fontan operation at two institutions and followed for a long time, freedom from reoperation for Fontan pathway obstruction was 99% at 1 year after operation and 96%, 86%, and 59%, respectively, at 5, 10, and 15 years after operation. The hazard function for reoperation had an initial very rapidly declining phase and a second phase that was still rising 15 years after operation. Twelve (17%; confidence limits [CL], 13% to 23%) of 69 patients with a right atrial to right ventricular conduit (valved or nonvalved) connection underwent reoperation for pathway obstruction, whereas only 2 (4%; CL, 1% to 10%) of 45 patients with a direct connection to the right ventricle required reoperation. Five (8%; CL, 4% to 13%) of 65 patients with a right atrial to pulmonary artery conduit connection required reoperation for pathway obstruction, and only 2 (1.3%; CL, 0.4% to 3%) of 155 patients with a direct right atrial to pulmonary artery connection required reoperation. These findings have implications as to the optimal technique of the Fontan operation and also as to use of an intraatrial tunnel as part of the repair.

Adolescent↗
PubMed1989

Long-term evaluation of direct repair of traumatic isthmic aortic transection.

Direct repair of traumatic aortic isthmic transection eliminates the late complications of prosthetic graft repair. This study evaluates the long-term fate of direct aortic repair to which little attention has been paid. Among 32 patients operated upon from 1965 to 1987, 27 (84%) underwent direct repair. The tear was circumferential in 15 patients and partial in 12. Multiple traumatic lesions were present in 26 patients, including intracranial injury in 19. Partial cardiopulmonary bypass was used in 15 patients and simple aortic cross-clamping in 12. No paraplegia was observed. There were 4 deaths from associated lesions among the 14 patients operated upon for acute traumatic isthmic transection and no deaths in the others. Among the 23 survivors, 4 were lost to follow-up; the other 19 patients have excellent clinical results. Intravenous digital aortic angiography performed in 14 patients at a mean delay of 5 years 3 months showed excellent aortic reconstruction in all cases. Technically more demanding and faster than a graft interposition, direct repair is recommended as the procedure of choice in the surgical treatment of traumatic isthmic transection, particularly in young patients, the group most at risk from this lesion.

Adolescent↗
PubMed1989

[Long-term results (6 to 17 years) of 372 mitral valve replacements using the Björk-Shiley prosthesis].

From November 1970 to December 1981, an isolated mitral valve replacement was performed in 372 patients (166 males - 206 females), ranging in age from 2 months to 76 years (mean age 49 years). Eighty-nine patients (24%) had previously undergone one or two cardiac operations. Only one of the 24 hospital deaths (6.4%) was related to the prosthesis (early thrombosis). Three hundred and fourty-eight patients were discharged from the hospital, 35 were lost to follow-up, and 313 were observed with a mean follow-up of 8 years 8 months (ranging from 5 years 2 months to 16 years 3 months). Ninety-two patients (29.4%) died from 2 months to 16 years post-operatively. Thirteen late deaths were from extra cardiac causes. Cardiac failure and thromboembolic or haemorrhagic complications represent the main causes of late mortality, respectively 10 and 6.7%. Twenty-one deaths were related to the prosthesis (10 thrombo-embolic accidents, 7 haemorrhagic complications and prosthesis could be discussed in 11 cases of sudden deaths and in 12 cases of death of undetermined causes. Among the 34 thrombo-embolic complications and the 13 perivalvular leakages (6 of them related to infection), 23 patients required reoperation, for valve thrombosis (14 cases with 2 deaths) or perivalvular leakage (9 cases with 2 deaths). Four other cases of valve thrombosis were treated with fibrinolytic agents with 1 death. The actuarial survival rate, hospital mortality excluded, is 69% at 10 years and 55% at 15 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1989

The size of the pulmonary arteries and the results of the Fontan operation.

All patients (n = 334) undergoing the Fontan operation at the University of Bordeaux, France, and the University of Alabama Medical Center, Birmingham, were entered into a single data base to examine the relation, if any, between size of the pulmonary arteries and outcome. Recent follow-up was made of all patients. The time-related freedom from death or takedown of the Fontan operation was 78% at 1 month, 73% at 6 months, and 72%, 68%, 61%, and 50% at 1, 5, 10, and 15 years after the operation. The hazard function (instantaneous risk of the combined event at each moment in time after the operation) had a rapidly declining early phase that gave way at about 6 months to a late phase of hazard, which began slowly to rise about 8 years after the operation. One of the most powerful risk factors for death or takedown of the Fontan operation was the dimensions of the right and left pulmonary arteries, expressed as a McGoon ratio. By multivariate analysis, the risk of the combined event increased sharply when the McGoon ratio was less than about 1.8, and when the ratio was as low as 1.2 the probability of death or takedown within 30 days of the operation was predicted to be 55% when the right atrium was connected to the pulmonary artery and 34% when connected to the right ventricle. Other risk factors identified were age at operation, the presence of mitral atresia, the degree of main chamber hypertrophy, elevated pulmonary artery pressure, non-use of cardioplegia, global myocardial ischemic time, and attachment of the right atrium to the pulmonary artery rather than to the right ventricle.

Blood Vessel Prosthesis↗
PubMed1988

Accuracy of M-mode and two-dimensional echocardiography in the diagnosis of aortic dissection: an experience with 128 cases.

The accuracy of combined M-mode and two-dimensional echocardiography in the diagnosis of aortic dissection was evaluated in 673 patients with a clinical suspicion of aortic dissection, over a six-year period. In 128 cases, the diagnosis of aortic dissection was confirmed by angiographic, tomographic (CT scan), or autopsy findings, or during surgery. Two echocardiographic features were found to support a diagnosis of aortic dissection: a dilation of at least one segment of the aorta (sensitivity 95%, specificity 51%) and a typical abnormal linear intraluminal echo corresponding to the intimal flap (sensitivity 67%, specificity 100%). This pathognomonic intimal flap was observed in 86 cases, of which three types could be distinguished: (1) a long oscillating flap (n = 15), (2) a long but minimally mobile linear echo which was duplicated and parallel to one or two aortic walls (n = 64), (3) a short, double linear image with a rapid systolic motion and high frequency oscillations. These features were found to have a high sensitivity in type I aortic dissection (88%), although in types II and III the sensitivity was much lower. In some cases, a fourth type of abnormal image could be detected: a small intraluminal echo moving in parallel to the aortic wall. This feature should be interpreted with caution since its predictive value for a positive examination was low (48%). Out of 23 cases in which the diagnosis of aortic dissection was suspected on the basis of this doubtful abnormal echo, it was confirmed in only 11 patients. The results in these 128 cases of aortic dissection indicate that two-dimensional echocardiography, which is easily performed at the patient's bedside, could take priority in investigations of this condition. It is extremely sensitive in the diagnosis of ascending aortic dissection, but much less so in the diagnosis of descending aortic dissection.

Aortic Dissection↗
PubMed1988

Exclusive double outlet right ventricle with atrioventricular concordance and pulmonary stenosis. Results of reconstructive surgery.

Double outlet right ventricle associated with atrioventricular concordance, pulmonary stenosis and situs solitus of the atria is a subset of double outlet right ventricle related through the surgical treatment. From 1974 to 1985, 14 patients, 5 males, 9 females (mean age 8.9 years, range 13 months-22 years) were operated upon. All patients had infundibular stenosis and normal or large pulmonary arteries. The apex of the heart was to the right in 2 patients, the right and left ventricles were superior and inferior in 2 patients and 1 patient had both anomalies. The ventricular septal defect was subaortic in 11 patients (aorto-mitral discontinuity in 5) and non-committed in 3 patients. Three patients had 2 ventricular septal defects. The aorta was anterior in 3 patients and to the right of the pulmonary artery in 11 patients. All patients, through a transventricular and transatrial approach, had a reconstructive surgery. In 3 patients, an aortic homograft valved conduit was used. One patient had the ventricular septal defect enlarged. There was one early death (7.1%) from high residual right ventricle pressure and no late death. One patient had a transient atrioventricular block. One patient was reoperated upon for a residual ventricular septal defect. All survivors had a good clinical result. Re-evaluation in 8 patients confirmed excellent haemodynamics: the right ventricle to pulmonary artery pressure gradient decreased from 80 mm Hg (range 60-95) preoperatively to 24 mm Hg (range 3-32) postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Should circulatory arrest with deep hypothermia be revised in aortic arch surgery?

Our experience (January 1982-May 1987) concerns 41 patients, operated upon for aortic dissection (30 patients) or aneurysm (11 patients) using circulatory arrest with deep hypothermia. There were 24 male and 17 female patients (mean age: 55 years 9 months, range 32-73 years). The mean circulatory arrest time in minutes was 41 +/- 3 (mean rectal temperature before circulatory arrest was 18.4 degrees C +/- 0.3 degrees C). Total (24 patients) or partial (16 patients) replacement of the aortic arch was performed. One patient with a sacciform aneurysm had the aortic wall defect closed. Hospital mortality was 22% +/- 7% (9 patients): 8 of 30 patients with aortic dissection (26.6%) and 1 of 11 patients with aortic aneurysm (9%). Neurological complications occurred in 3 patients. These data lead us to prefer circulatory arrest with deep hypothermia as the method of choice for aortic arch surgery. However, when a short circulatory arrest time (less than 30 min) for the repair is foreseeable, mild hypothermia (20 degrees C-24 degrees C) may be preferred. In patients who will not tolerate excessive cardiopulmonary bypass times, expected difficulties with the repair should suggest mild hypothermia and short circulatory arrest in easier cases or moderate hypothermia with brachiocephalic perfusion in the others.

Adult↗