Cirugía de Fontan: experiencia inicial y resultados tempranos

Abstract

Introduction: Fontan procedure, first performed in 1968 as palliation for tricuspid atresia, is indicated for heart disease with single ventricle physiology. In the procedure, caval blood is drained into the pulmonary arteries, through an interatrial or extracardiac tunnel, to which a fenestra is made draining into the pulmonary atrium. Prior preparation, with surgical procedures such as systemic-pulmonary fistula or Glenn's procedure, is crucial in achieving an adequate pulmonary vascular bed and avoiding system failure. Objective: To report the first cases of Fontan procedure at Centenario Hospital Miguel Hidalgo and evaluate the results in the short term. Methods: This is an observational, descriptive, and retrospective study. The records of single ventricle physiology patients from 2000 to 2018 were reviewed. Results: Fontan procedure has been performed since 2015, using a three-stage protocol. Three men and 2 women had undergone surgery, tricuspid atresia being the most frequent diagnosis. All underwent echocardiographic evaluation and previous catheterization. The procedure is performed with ventricular assistance, and without aortic impingement, an extracardiac tunnel with a polytetrafluoroethylene graft and latero-lateral fenestration to the right atrium is placed. The immediate mortality was 2 patients due to cardiogenic and septic shock. The most frequent early complications were pleural effusion (n = 3/5) and hemorrhage (n = 2/5). All received thromboprophylaxis with antiplatelet aggregation without thromboembolic events. Conclusions: The currently reported mortality cannot be considered as absolute in the center since the beginning of this surgery is recent at the hospital and the volume small. Due to the complexity of the procedure, it will undergo a constant and rigorous evaluation of the results comparing techniques and outcomes in other national and international groups to improve our performance and quality of care. . LUX MÉDICA AÑO 15, NÚMERO 43, ENERO-ABRIL 2020. PP

Keywords: single ventricle physiology, tricuspid atresia, total cavopulmonary