Skip to main content
SpringerLink
Log in

Lateral Atrial Tunnel Fontan Operation Predisposes to the Junctional Rhythm

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

The goal of the study was to compare the early postoperative course after fenestrated lateral atrial tunnel (LT) and non-fenestrated extracardiac conduit (EC) Fontan operation (FO) in a single center where both techniques were parallelly used. Between 2004 and 2012, 56(32.7%) children underwent LT and 113(66.1%) EC FO. The mean age was 3.7 ± 2.9 years and mean weight was 14.6 ± 7.3 kg. The most common malformation was hypoplastic left heart syndrome (50.9%). The general approach was to perform LT in children after hemi-Fontan operation and EC in patients after Glenn anastomosis. Medical records were retrospectively reviewed. The hospital survival was 100%. In EC group, cardiopulmonary bypass time (CPB) was shorter (p = 0.004) and less patients needed aortic cross-clamping (p < 0.001). Children after EC stayed longer in the hospital (p = 0.016) and manifested more often prolonged effusions (p = 0.038). The incidence of all forms of junctional rhythm was higher in the LT group, early postoperatively (p < 0.001), during hospitalization (p = 0.004) and at discharge (p < 0.001). Children after LT required more often temporary pacemaker stimulation (p < 0.001). Patients without postoperative normofrequent sinus rhythm had longer CPB time (p = 0.008) and were more often operated on with aortic cross-clamping (p = 0.028). Lateral atrial tunnel Fontan operation with fenestration facilitates early adaptation to the total passive pulmonary flow, but predisposes the patients to the loss of sinus rhythm. The crucial role in the preservation of sinus rhythm plays the last step of the multistage surgery of the single ventricle malformations, probably not only the surgical technique but also factors associated with the cardiopulmonary bypass.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fontan F, Baudet E (1971) Surgical repair of tricuspid atresia. Thorax 26:240–248

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kreutzer G, Galíndez E, Bono H, De Palma C, Laura JP (1973) An operation for the correction of tricuspid atresia. J Thorac Cardiovasc Surg 66:613–621

    CAS  PubMed  Google Scholar 

  3. Ghai A, Harris L, Harrison DA, Webb GD, Siu SC (2001) Outcomes of late atrial tachyarrhythmias in adults after the Fontan operation. J Am Coll Cardiol 37:585–592

    Article  CAS  PubMed  Google Scholar 

  4. Stamm C, Friehs I, Mayer JE, Zurakowski D, Triedman JK, Moran AM et al (2001) Long-term results of the lateral tunnel Fontan operation. J Thorac Cardiovasc Surg 121:28–41

    Article  CAS  PubMed  Google Scholar 

  5. Balaji S, Daga A, Bradley DJ, Etheridge SP, Law IH, Batra AS et al (2014) An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations. J Thorac Cardiovasc Surg 148:576–581

    Article  PubMed  Google Scholar 

  6. Cohen MI, Wernovsky G, Vetter VL, Wieand TS, Gaynor JW, Jacobs ML et al (1998) Sinus node function after a systematically staged Fontan procedure. Circulation 98:II352-11358.

    Article  Google Scholar 

  7. Jacobs ML, Pelletier GJ, Pourmoghadam KK, Mesia CI, Madan N, Stern H et al (2008) Protocols associated with no mortality in 100 consecutive Fontan procedures. Eur J Cardiothorac Surg 33:626–632

    Article  PubMed  Google Scholar 

  8. Petrossian E, Reddy VM, McElhinney DB, Akkersdijk GP, Moore P, Parry AJ et al (1999) Early results of the extracardiac conduit Fontan operation. J Thorac Cardiovasc Surg 117:688–696

    Article  CAS  PubMed  Google Scholar 

  9. Fiore AC, Turrentine M, Rodefeld M, Vijay P, Schwartz TL, Virgo KS et al (2007) Fontan operation: a comparison of lateral tunnel with extracardiac conduit. Ann Thorac Surg 83:622–630

    Article  PubMed  Google Scholar 

  10. de Leval MR, Kilner P, Gewillig M, Bull C (1988) Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg 96:682–695

    PubMed  Google Scholar 

  11. Marcelletti C, Corno A, Giannico S, Marino B (1990) Inferior vena cava-pulmonary artery extracardiac conduit. A new form of right heart bypass. J Thorac Cardiovasc Surg 100:228–232

    CAS  PubMed  Google Scholar 

  12. Shirai LK, Rosenthal DN, Reitz BA, Robbins RC, Dubin AM (1998) Arrhythmias and thromboembolic complications after the extracardiac Fontan operation. J Thorac Cardiovasc Surg 115:499–505

    Article  CAS  PubMed  Google Scholar 

  13. Lardo AC, Webber SA, Friehs I, del Nido PJ, Cape EG (1999) Fluid dynamic comparison of intra-atrial and extracardiac total cavopulmonary connections. J Thorac Cardiovasc Surg 117:697–704

    Article  CAS  PubMed  Google Scholar 

  14. Bove EL, de Leval MR, Migliavacca F, Guadagni G, Dubini G (2003) Computational fluid dynamics in the evaluation of hemodynamic performance of cavopulmonary connections after the Norwood procedure for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 126:1040–1047

    Article  PubMed  Google Scholar 

  15. Hasselman T, Schneider D, Madan N, Jacobs M (2005) Reversal of fenestration flow during ventricular systole in Fontan patients in junctional or ventricular paced rhythm. Pediatr Cardiol 26:638–641

    Article  CAS  PubMed  Google Scholar 

  16. Rychik J, Fogel MA, Donofrio MT, Goldmuntz E, Cohen MS, Spray TL et al (1997) Comparison of patterns of pulmonary venous blood flow in the functional single ventricle heart after operative aortopulmonary shunt versus superior cavopulmonary shunt. Am J Cardiol 80:922–926

    Article  CAS  PubMed  Google Scholar 

  17. Bae EJ, Lee JY, Noh CI, Kim WH, Kim YJ (2003) Sinus node dysfunction after Fontan modifications–influence of surgical method. Int J Cardiol 88:285–291

    Article  PubMed  Google Scholar 

  18. Azakie A, McCrindle BW, Van Arsdell G, Benson LN, Coles J, Hamilton R et al (2001) Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: impact on outcomes. J Thorac Cardiovasc Surg 122:1219–1228

    Article  CAS  PubMed  Google Scholar 

  19. Kumar SP, Rubinstein CS, Simsic JM, Taylor AB, Saul JP, Bradley SM (2003) Lateral tunnel versus extracardiac conduit Fontan procedure: a concurrent comparison. Ann Thorac Surg 76:1389–1397

    Article  PubMed  Google Scholar 

  20. Cohen MI, Bridges ND, Gaynor JW, Hoffman TM, Wernovsky G, Vetter VL et al (2000) Modifications to the cavopulmonary anastomosis do not eliminate early sinus node dysfunction. J Thorac Cardiovasc Surg 120:891–900

    Article  CAS  PubMed  Google Scholar 

  21. Rodefeld MD, Bromberg BI, Schuessler RB, Boineau JP, Cox JL, Huddleston CB (1996) Atrial flutter after lateral tunnel construction in the modified Fontan operation: a canine model. J Thorac Cardiovasc Surg 111:514–526

    Article  CAS  PubMed  Google Scholar 

  22. Ho SY, Seo JW, Brown NA, Cook AC, Fagg NL, Anderson RH (1995) Morphology of the sinus node in human and mouse hearts with isomerism of the atrial appendages. Br Heart J 74:437–442

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Wu MH, Wang JK, Lin JL, Lai LP, Lue HC, Hsieh FJ (2001) Cardiac rhythm disturbances in patients with left atrial isomerism. PACE 24:1631–1638

    Article  CAS  PubMed  Google Scholar 

  24. Durongpisitkul K, Porter CJ, Cetta F, Offord KP, Slezak JM, Puga FJ et al (1998) Predictors of early- and late-onset supraventricular tachyarrhythmias after Fontan operation. Circulation 98:1099–1107

    Article  CAS  PubMed  Google Scholar 

  25. Mosca RS, Kulik TJ, Goldberg CS (2000) Early results of the Fontan procedure in one hundred consecutive patients with hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 119:1110–1118

    Article  CAS  PubMed  Google Scholar 

  26. Bridges ND, Mayer JE Jr, Lock JE, Jonas RA, Hanley FL, Keane JF et al (1992) Effect of baffle fenestration on outcome of the modified Fontan operation. Circulation 86:1762–1769

    Article  CAS  PubMed  Google Scholar 

  27. Day RW, Boyer RS, Tait VF, Ruttenberg HD (1995) Factors associated with stroke following the Fontan procedure. Pediatr Cardiol 16:270–275

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Geb. A1, 48149, Muenster, Germany

    Katarzyna Januszewska & Edward Malec

  2. Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilian-University, Klinikum Großhadern, Marchioninistr.15, 81377, Munich, Germany

    Anna Schuh, Anja Lehner & Robert Dalla-Pozza

Authors
  1. Katarzyna Januszewska
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Schuh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anja Lehner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert Dalla-Pozza
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Edward Malec
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katarzyna Januszewska.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Januszewska, K., Schuh, A., Lehner, A. et al. Lateral Atrial Tunnel Fontan Operation Predisposes to the Junctional Rhythm. Pediatr Cardiol 38, 712–718 (2017). https://doi.org/10.1007/s00246-017-1571-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-017-1571-3

Keywords

Search

Navigation