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Biomedical subjects

F Fontan

Publications and source records attributed to F Fontan.

At least 55 records · Page 3Linked to original sources
PubMed1983

Repair of tricuspid atresia in 100 patients.

One hundred consecutive patients with situs solitus of the atria and tricuspid atresia have undergone surgical repair since 1968. In patients with ventriculoarterial concordance, a nonvalved Dacron conduit or an aortic valve homograft was interposed between the right atrium and right ventricular outlet chamber. In patients with ventriculoarterial discordance, an aortic valve homograft established continuity between the right atrium and pulmonary artery. Among 73 patients with ventriculoarterial concordance, the hospital mortality rate was 11% (eight deaths), and in 27 patients with ventriculoarterial discordance, it was 15% (four deaths). Before 1974, the year of operation was a significant determinant of hospital mortality (p less than 0.001). Thereafter, the hospital mortality declined and is currently 3.7%. In 82 patients with ages ranging from 4 to 16 years, there were six deaths (7.3%) whereas there were six deaths (33.3%) in 18 patients less than 4 or more than 16 years (p less than 0.001). Mode of ventriculoarterial connection and type of repair did not influence significantly the hospital mortality. There were six late deaths due to infection (two), reoperation (two), heart failure (one), and sudden death (one). Regardless of the mode of ventriculoarterial connection, use of a homograft valve produced better results, i.e., more asymptomatic patients (NYHA Class I) (p = 0.0168) and higher postoperative exercise capacity. Postoperative catheterization data and angiocardiographic measurements in patients with ventriculoarterial concordance demonstrated significant advantages with the interposition of a homograft valve between the right atrium and outlet chamber. Of 82 surviving patients, 94% are in NYHA Class I or II.

Adolescent↗
PubMed1982

Nine years' experience of physiological correction of tricuspid atresia: long-term results and current surgical approach.

Fontan's correction has been performed without early death in 24 consecutive patients with tricuspid atresia. Eighteen patients had ventriculoarterial concordance (group I) and six discordance (group II). Late death related to infections occurred in three patients. The follow-up time in group I (16 survivors) ranges from 1 year 10 months to 7 years 5 months (mean 3 years 8 months) and in group II (five survivors) from 2 years 1 month to 5 years 6 months (mean 3 years 6 months). Early postoperative cardiac catheterisation showed arterial pulsatile pressure recordings in the pulmonary artery only in two patients in group I, in whom a valved conduit was used to connect the right atrial appendage with the outlet chamber. Patients with a valved conduit connected with either the pulmonary artery (group II) or the outlet chamber (two patients of group I) showed better preservation of right atrial contractions angiocardiographically and scored better in exercise tests than did patients with a non-valved conduit (14 patients of group I). In the latter patients evidence of regurgitant bloodflow from the outlet chamber into the right atrium was found. Reoperation was necessary in two patients. The outlet chambers showed a substantial increase in diameter after operation. No disturbances of kidney or liver function were found up to seven years after operation. The clinical condition has improved considerably in all survivors. It is concluded that the use of a valved conduit is preferable for connecting the pulmonary artery directly in cases of tricuspid atresia with ventriculoarterial discordance or the outlet chamber when there is ventriculoarterial concordance.

Adolescent↗
PubMed1982

[Left ventricular aneurysms. Prognostic study. Operative results].

Eighty three patients with symptomatic post-myocardial infarction left ventricular aneurysms (cardiac failure: 62 cases; angina; 41 cases; ventricular arrhythmias: 37 cases; systemic embolism: 8 cases) underwent surgery between 1975 and March 1981. Preoperative investigations comprised clinical examination, left heart catheterisation and ventriculography. End systolic and end diastolic volumes, ejection fraction velocity of circumferential fibre shortening, and the akinetic surface area were calculated firstly for the whole of the left ventricle and then for the contractile zones after hypothetical resection of the aneurysm. Selective coronary angiography was carried out in 75 patients. The results were as follows: 16 perioperative fatalities (19.2 p. 100): Group IA; 14 late deaths or not improvement after surgery (17 p. 100): Group IB; 53 patients had little or no symptoms after surgery (63 p. 100), Group II. The 5 year survival rats is 69.7 p. 100. Severe cardiac failure (Stages III or IV of the NYHA Classification) is associated with a poor prognosis (33 p. 100 mortality). The hemodynamic parameters of the whole ventricle (end diastolic volume, global ejection fraction) had little or no correlation with the outcome. The ejection fraction of the contractile zones was significantly lower in Groups IA and IB (0.39 +/- 0.08, and 0.41 +/- 0.05) than in Group II (0.51 +/- 0.05), p less than 0.001). When the ejection fraction of the contractile zone exceeded 0.45, good results were obtained in 90 p. 100 of cases. The velocity of circumferential fibre shortening was also a good prognostic index (0.63 +/- 0.18 in Group IA compared to 1.10 +/- 0.09 in Group II, p less than 0.001). On the other hand, the diastolic volume of the contractile zone was very variable in all three groups. Extensive coronary artery disease not treated surgically worsened the prognosis (50 p. 100 mortality in triple vessel disease.) Seven of the 8 patients operated during the acute phase of myocardial infarction (less than I month) died, but they all had very poor hemodynamic parameters.

Adult↗
PubMed1981

Surgical constriction of the pulmonary artery. A new experimental technique.

The classical "banding" of the pulmonary arterial trunk (PAT) is often difficult to remove at the time of definite repair of the cardiac congenital malformation; often its removal alone requires the use of a cardiopulmonary bypass and an angioplasty of the PAT. These difficulties have led the authors to study experimentally, in 16 dogs, the value of a palliative stenosis of the PAT by lateral compression (LC) of the arterial wall. Three types of compressing materials have been used: Teflon band wrapped in pericardium (5 dogs), cuneiform pieces made of either Teflon (5 dogs), or stainless steel (6 dogs). The experiment has led to the following conclusions: 1. The LC of the PAT is able to create a pressure gradient which tends to decrease when the animal is growing. 2. Cuneiform pieces made of Teflon or stainless steel should be used to realize the LC. 3. After the LC has been removed the PAT recovers its normal shape, as attested by absence of a systolic pressure gradient across the PAT. This technique of LC seems to be an interesting alternative to creating a temporary palliative stenosis of the PAT.

Animals↗
PubMed1981

[Value of intravenous nitroglycerin in hypertension after extracorporeal circulation].

The authors compare the haemodynamic effects of intravenous nitroglycerin (IV TNT) in 14 patients developing hypertension (mean blood pressure greater than 90 mmHg) and in seven normotensive patients (70 less than mean blood pressure less than 90 mmHg) after cardiac surgery with extracorporeal circulation (ECC). TNT was administered at doses of 0.5, 1, 2 microgram.kg-1.min-1 then 2 microgram.kg-1.min-1 with the association of vascular filling in order to restore right and left arterial pressures to their initial values. Various haemodynamic parameters were measured or calculated. The results obtained: in the hypertensive patients, at the low dose (0.5 microgram.kg-1.min-1) a prevalent venodilatory action was noted: RAP: 7.64 +/- 2.76 p less than 0.05; LAP: 9.07 +/- 3.19 p less than 0.05; at the middle dose (1 microgram.mg-1.min-1) venodilation continued resulting in a fall in BP 95.28 +/- 26.11 p less than 0.01 and above all in Cl: 2.28 +/- 0.36 p less than 0.01; at the maximum dose used, the action of TNT affected both the venous and arteriolar sector causing a major fall in BP: 89.64 +/- 23.88 p less than 0.001, in Cl: 2.29 +/- 0.33 p less than 0.01 and above all RVSI: 19.94 +/- 6.24 p less than 0.05. The association of vascular filling led to an increase in RAP and LAP (p = NS), Cl (p = NS) whilst BP remained low: 92.78 +/- 17.56 p less than 0.001 and also RVSI: 18.12 +/- 4.44 p less than 0.01. In the normotensive patients the administration of TNT, whatever the dose used, did not cause any significant changes (p = NS). In conclusion, the authors emphasise the value of the use of TNT in postoperative hypertensive states, in particular when associated with myocardial ischaemia.

Adult↗
PubMed1980

Palliative reconstruction of the right ventricular outflow tract in tricuspid atresia: a report of 5 patients.

Five patients with tricuspid atresia, normally related great arteries, and decreased pulmonary flow underwent reconstruction of the right ventricular outflow tract on enlargement of the ventricular septal defect (VSD) (outlet foramen) or both in order to increase pulmonary blood flow. The age of the patients ranged from 9 months to 4 years. All patients previously had had a systemic-pulmonary artery anastomosis. Preoperative mean arterial oxygen saturation was 67.2%. A restrictive outlet foramen was enlarged in 3 patients. Infundibulectomy and enlargement of the outlet chamber with a Dacron patch were performed in 4 patients. A pulmonary valve commissurotomy alone was done in 1 patient. There were no hospital or late deaths (mean follow-up, 16 months). Four patients out of 5 have obtained symptomatic and documented (increase in partial pressure of oxygen) benefit. In 1 patient, arterial oxygen saturation failed to rise to a satisfactory level.

Child, Preschool↗
PubMed1980

[Effect of intravenous nytroglicerin in hypertensive patients during and after open heart surgery (author's transl)].

The present study was performed to compare hemodynamic effect of intravenous Nitroglycerin (TNT i.v.) in 14 patients developing acute hypertension (Group I) and in 7 non hypertensives after open heart surgery (Group II). In all patients, m.a. 56.6 yrs, (10 mitral and/or aortic prosthetic valve replacements, 9 aorto-coronary bypass, 1 open mitral commissurotomy, 1 closure of atrial septal defect) TNT was infused at doses of 0.5, 1, 2 microgram X kg X min. and subsequently at 2 microgram X kg X min. after volume administration (2 + V.A.) to maintain right and left atrial pressure the same as control (P = N.S.). Mean arterial, right and left atrial pressures (MAP, RAP, LAP), cardiac frequency and index (CF, CI and systemic vascular resistance index (SVRI) were monitorized. TNT i.v. resulted in hypertensive patients (Group I) in reduction vs. control of: a) RAP (--20.17%) and LAP (--20.58%) at 0.5 microgram X kg X min. b) RAP (--26.13%), LAP (--27.50%), MAP (--19.94%) and CI (--12.98%) at 1 microgram X kg X X min. c) RAP (--22.47%), LAP (--26.89%), MAP (--24.68%), CI (--12.6%) and SVRI (--17.34%) at 2 microgram X kg X min. When RAP and LAP was maintained by volume administration TNT i.v. (2 microgram X kg X min.) resulted in an even greater increase in CI and a greater decrease in MAP and SVRI ((--22.04% and --24.88% respectively). No significant hemodynamic modification (P less than or equal to 0.05) were observed in non hypertensive patients (Group II) at all doses of TNT i.v. The results confirm a predominant venodilator effect of TNT at low doses and a good effect on arterial resistances at high doses in hypertensive patients. In view of previous reports of differing effects on ischemia TNT i.v. may be preferable to other vasodilator drugs for control of acute post-ECG hypertension, only on condition to maintain an adequate left ventricular filling pressure to prevent a fall of cardiac index. Moreover the absence of significant (P less than or equal to 0.05) hemodynamic modifications in non hypertensive patients may be a further advantage in the treatment of myocardial ischemia with i.v. TNT.

Adult↗
PubMed1978

[Left ventricular aneurysms. Hemodynamic studies and surgical results].

The cardiac function of 37 cases of ventricular dyskinesia were studied by cineangiography. The amplitude and speed of contraction of the contracting parts was evaluated as well as the volume of the akinetic zone. A score of coronary artery obstruction was made for those patients who underwent coronary arteriography. All the patients had resection of their aneurysm. Four patients died in the immediate post-operative period. Six patients developed a temporary low output state requiring circulatory assistance. Twenty-seven patients were operated on successfully without posing any haemodynamic problem. Good immediate and late post-operative results were associated with an ejection fraction of the contracting part greated than 0,40, a dyskinetic area less than 40% and a coronary artery obstruction index of less than 6. Resection of the aneurysm, sometimes associated with aorto-coronary bypass grafting (5 cases), led to a marked improvement in heart failure and/or disappearance of ventricular arrhythmias.

Adult↗