▫La cirugía busca minimizar los factores de riesgo que acechan al Norwood estadio I Fontan atriopulmonar: Conexión de AD con TP para q sangre de. The Fontan procedure or Fontan–Kreutzer procedure is a palliative surgical procedure used in from their existing blood supply (e.g. a shunt created during a Norwood procedure, a patent ductus arteriosus, etc.). Leval, Marc R de ( ). d Servicio de Cirugía Cardiovascular, Hospital Infantil Universitario Virgen del Between October and June , 42 children underwent the Norwood.

Author: Zuluk Maramar
Country: Anguilla
Language: English (Spanish)
Genre: Business
Published (Last): 25 August 2009
Pages: 340
PDF File Size: 7.94 Mb
ePub File Size: 14.92 Mb
ISBN: 199-4-76950-842-3
Downloads: 61584
Price: Free* [*Free Regsitration Required]
Uploader: Shakashakar

July Next article. Impedance cardiography Ballistocardiography Cardiotocography. Because of this, some authors support the systematic use of ventricular assist devices in the operating room and during the patients stay in the PICU, arguing that it improves cardiac output and therefore the survival, of these patients.

The tissue oxygen extraction and venous pCO 2 allow the determination of cardiac output. Nelson Textbook of Pediatrics 17th ed. Norowod use has demonstrated in other studies an improvement in hemodynamics, reflected as a reduction in the heart rate and an incremented in the systolic and diastolic pressure. The time of aortic clamping only was significant when we compared it with the surgical technique, so that it was superior in children of group 1 Table 7.

Some of the quantitative variables did not follow a normal distribution test of Kolmogorov-Smirnovreason for which they were described as a mean interquartile range.

Fontan procedure – Wikipedia

This procedure improves the growth of the pulmonary arteries with a more uniform distribution. Jack Rychik, head of the Single Ventricle Survivorship Program at Children’s Hospital of Philadelphia summarized the long-term consequences of Fontan circulation as an “indolent and progressive state of heart failure” with predictable long term consequences on several organ systems. The one obtained in group 1 was Please help improve this article by adding citations to reliable sources.

At this point, the oxygen-poor blood from upper and lower body flows through the lungs without being pumped driven only by the pressure that builds up in the veins. We did not find significant differences either between mortality in PICU and the surgical technique used.


Primary sternum closure was also a risk factor in the sense that the children that underwent such a procedure in the operating room had a higher mortality, both intrasurgically Table 6 as postsurgically in the PICU Table 3.

Fontan procedure is also contraindicated in those with pulmonary artery hypoplasia, patients with left ventricular dysfunction and significant mitral insufficiency. Concerns about damage to the liver have emerged more recently, as Fontan circulation produces congestion and lymphedema in this organ which leads to progressive hepatic fibrosis.

When the pressure in the veins is high, some of the oxygen-poor blood can escape through the fenestration to relieve the pressure.

The single ventricle cirugi doing nearly twice the expected amount of work because it has to pump blood for the body and lungs.

Due to the advancements in medical and surgical treatments, survival of these children in the past years has increased, but they must be intervened 3 times throughout noewood life, with the risk inherent to this. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License.

Fontan procedure

This article needs additional citations for verification. In the short term, children can norwoood trouble with pleural effusions fluid building up around the lungs.

In a similar manner to other authors, 12 we have also proven that time on ECC is a risk factor for early mortality in the PICU, in the sense that the longer the time on ECC, the most likely the patient will die.

The mean age and the weight of them in the last review was 19 months range, and 9 kg range, 6. Its measurement evaluates in an indirect form the pulmonary flow and allows identifying children with a jeopardized pulmonary flow.

In a review, Dr. The work done in the previous years has improved short and long-term survival. Eight had hypoplastic heart syndrome and five had a single ventricle with aortic arch hypoplasia.

Guillermo Kreutzer from Buenos Aires, Argentina b. The Fontan procedure or Fontan—Kreutzer procedure is a palliative surgical procedure used in children with univentricular hearts. Cardiac arrest with profound hypothermia was used in all and regional cerebral perfusion was used in nine.


All of our patients underwent hyperfiltration during their time on ECC, without any complications, and without the necessity of suspending it owing to hemodynamic instability.

Experience With the Norwood Operation for Hypoplastic Left Heart Syndrome

To address this risk, some surgeons make a fenestration from the venous circulation into the atrium. The main problem of this intervention is the hemodynamic instability; in order to try and avoid it, in year the modification of Shunji Sano, 4 consisting of the substitution of the fistula for a non-valvulated tube introduced between the right ventricle and the pulmonary artery.

These differences, which relate the cardiac anatomy to hospital mortality, although spectacular, did not have statistical meaning. Both patients died due to respiratory insufficiency before a tensile stent could be implanted in the bronchial light. Retrospective analysis of all patients subjected to the Norwood procedure between February and June This mortality can be considered high if we compare it with that obtained by other authors.

All the analyses were virugia with SPSS software, version The diagnosis was done in utero in eight patients.

Nature Clinical Practice Cardiovascular Medicine. Cardiac surgery Congenital heart defects Pediatric surgical procedures Thoracic surgical procedures. Journal of the American College of Cardiology. Both a long cardiopulmonary bypass time and primary sternal closure were associated with increased mortality.

Two cases had respiratory insufficiency that made weaning off ventilation difficult, finding a dynamic obstruction of the left main bronchus by means of fibrobronchoscopy. Norwood procedure is used as the first stage in the palliative treatment of the hypoplastic heart syndrome and can be used, with some technical modifications, in other forms of univentricular heart with aortic stenosis or hypoplasia.