The concept of Fontan circulation was first clinically introduced in 1971. Since that time, many technical modifications have been advocated. Among them, the concept of total cavopulmonary connection, introduced in the late 80's [1], has experienced widespread use over the past 10 years. In this procedure, a bidirectional superior cavopulmonary anastomosis is performed while the inferior caval blood flow is directed towards the pulmonary arteries through an intraatrial composite tunnel. More recently, an extracardiac conduit to divert inferior vena cava flow to the pulmonary arteries has been advocated [2]
[3]
[4]. The respective merits of these two approaches remain to be determined.
Key words:
Functioning single ventricle - Fontan circulation
References
-
1
de Leval M R, Kilner P, Gewillig M. et al .
Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience.
J Thorac Cardiovasc Surg.
1988;
96
682-695
-
2
Marcelletti C, Corno A, Giannico S. et al .
Inferior vena cava-pulmonary artery extracardiac conduit. A new form of right heart bypass.
J Thorac Cardiovasc Surg.
1990;
100
228-232
-
3
Lashinger J C, Redmond J M, Cameron D E. et al .
Intermediate results of the extracardiac Fontan procedure.
Ann Thorac Surg.
1996;
62
1261-1267
-
4
Petrossian E, Reddy V M, Mc Elhinney D B. et al .
Early results of the extracardiac conduit Fontan operation.
J Thorac Cardiovasc Surg.
1999;
117
688-696
-
5
Burke R P, Jacobs J P, Ashraf M H. et al .
Extracardiac Fontan operation without cardiopulmonary bypass.
Ann Thorac Surg.
1997;
63
1175-1177
-
6
De Leval M R, Dubini G, Migliavacca F. et al .
Use of computational fluid dynamics in the design of surgical procedures : application to the study of competitive flows in cavopulmonary connections.
J Thorac Cardiovasc Surg.
1996;
111
502-513
-
7
Sharma S, Gondy S, Walker P. et al .
In vitro flow experiments for the determination of optimal geometry of total cavopulmonary connection for surgical repair of children with functional single ventricle.
J Am Coll Cardiol.
1996;
27
1264-1269
-
8
Lardo A C, Webber S A, Friehs I. et al .
Fluid dynamic comparison of intra-atrial and extracardiac total cavopulmonary connections.
J Thorac Cardiovasc Surg.
1999;
117
697-704
-
9
Migliavacca F, de Leval M R, Dubini G. et al .
Computational fluid dynamic simulations of cavopulmonary connection with an extracardiac lateral conduit.
Med Engl Phys.
1999;
21
187-193
-
10
Rodefeld M D, Bromberg B I, Schuessler R B. et al .
Atrial flutter after lateral tunnel construction in the modified Fontan operation : a canine model.
J Thorac Cardiovasc Surg.
1996;
111
514-526
-
11
Amodeo A, Galletti L, Marianeschi S. et al .
Extracardiac Fontan operation for complex cardiac anomalies : seven years' experience.
J Thorac Cardiovasc Surg.
1997;
114
1020-1031
-
12
Jahangiri M, Ross D B, Redington A N. et al .
Thromboembolism after the Fontan procedure and its modifications.
Ann Thorac Surg.
1994;
58
1409-1414
-
13
Van Son J A, Reddy M V, Hanley F L.
Extracardiac modification of the Fontan operation without use of prosthetic material.
J Thorac Cardiovasc Surg.
1995;
110
1766-1768
-
14
Grundy S R, Razzouk A J, del Rio M J. et al .
The optimal Fontan connection: a growing extracardiac lateral tunnel with pedicled pericardium.
J Thorac Cardiovasc Surg.
1997;
114
552-558
-
15
Ziemer G, Heinemann M K.
Preparatory surgical stent placement facilating extracardiac vascular connections.
Ann Thorac Surg.
1999;
68
1431-1432
-
16
Yeh T, Williams W G, Mc Crindle B W. et al .
Equivalent survival following cavopulmonary shunt with or without the Fontan procedure.
Eur J Cardio-thorac Surg.
1999;
16
111-116
P. R. Vouhé
Groupe Hospitalier Necker Enfants-Malades Service de Chirurgie Cardiaque Pédiatrique
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