Abstract
Pulmonary vascular structure was analysed in the lungs of 12 patients who had had a Fontan repair, 11 of whom died. Of the eight patients with a low pulmonary blood flow preoperatively, pulmonary vascular structure was almost normal in seven, but in the remaining patient many intra-acinar arteries contained organised occlusive thrombi. Of the four patients with an increased pulmonary blood flow immediately before operation, there was a significant increase in pulmonary vascular smooth muscle despite three of the patients having had a pulmonary arterial band. The findings suggest that it is more difficult for patients with an increased pulmonary blood flow to fulfil the Fontan criteria for repair, and even when the pulmonary vascular resistance is less than 4 units/m2 there may be significant pulmonary vascular abnormalities likely to increase right atrial afterload and prejudice the outcome of a Fontan repair.
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- Björk V. O., Olin C. L., Bjarke B. B., Thorén C. A. Right atrial-right ventricular anastomosis for correction of tricuspid atresia. J Thorac Cardiovasc Surg. 1979 Mar;77(3):452–458. [PubMed] [Google Scholar]
- Bull C., de Leval M. R., Stark J., Taylor J. F., Macartney F. J. Use of a subpulmonary ventricular chamber in the Fontan circulation. J Thorac Cardiovasc Surg. 1983 Jan;85(1):21–31. [PubMed] [Google Scholar]
- Fontan F., Baudet E. Surgical repair of tricuspid atresia. Thorax. 1971 May;26(3):240–248. doi: 10.1136/thx.26.3.240. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gale A. W., Danielson G. K., McGoon D. C., Mair D. D. Modified Fontan operation for univentricular heart and complicated congenital lesions. J Thorac Cardiovasc Surg. 1979 Dec;78(6):831–838. [PubMed] [Google Scholar]
- Gale A. W., Danielson G. K., McGoon D. C., Wallace R. B., Mair D. D. Fontan procedure for tricuspid atresia. Circulation. 1980 Jul;62(1):91–96. doi: 10.1161/01.cir.62.1.91. [DOI] [PubMed] [Google Scholar]
- HEATH D., DUSHANE J. W., WOOD E. H., EDWARDS J. E. The aetiology of pulmonary thrombosis in cyanotic congenital heart disease with pulmonary stenosis. Thorax. 1958 Sep;13(3):213–217. doi: 10.1136/thx.13.3.213. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hislop A., Reid L. New pathological findings in emphysema of childhood. 1. Polyalveolar lobe with emphysema. Thorax. 1970 Nov;25(6):682–690. doi: 10.1136/thx.25.6.682. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hislop A., Reid L. Pulmonary arterial development during childhood: branching pattern and structure. Thorax. 1973 Mar;28(2):129–135. doi: 10.1136/thx.28.2.129. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kreutzer G. O., Vargas F. J., Schlichter A. J., Laura J. P., Suarez J. C., Coronel A. R., Kreutzer E. A. Atriopulmonary anastomosis. J Thorac Cardiovasc Surg. 1982 Mar;83(3):427–436. [PubMed] [Google Scholar]
- Rabinovitch M., Haworth S. G., Vance Z., Vawter G., Castaneda A. R., Nadas A. S., Reid L. M. Early pulmonary vascular changes in congenital heart disease studied in biopsy tissue. Hum Pathol. 1980 Sep;11(5 Suppl):499–509. [PubMed] [Google Scholar]
- Tandon R., Edwards J. E. Tricuspid atresia. A re-evaluation and classification. J Thorac Cardiovasc Surg. 1974 Apr;67(4):530–542. [PubMed] [Google Scholar]