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Reflections on Five Decades of the Fontan Kreutzer Procedure

The first successful total right heart bypass via atriopulmonary anastomosis (APA) were reported in 1971 for patients with tricuspid atresia. At the Children’s Hospital of Buenos Aires, the cohort of such procedures started in July, when the first fenestrated right heart by pass was performed, with...

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Autores principales: Kreutzer, Christián, Kreutzer, Jacqueline, Kreutzer, Guillermo O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866802/
https://www.ncbi.nlm.nih.gov/pubmed/24400290
http://dx.doi.org/10.3389/fped.2013.00045
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author Kreutzer, Christián
Kreutzer, Jacqueline
Kreutzer, Guillermo O.
author_facet Kreutzer, Christián
Kreutzer, Jacqueline
Kreutzer, Guillermo O.
author_sort Kreutzer, Christián
collection PubMed
description The first successful total right heart bypass via atriopulmonary anastomosis (APA) were reported in 1971 for patients with tricuspid atresia. At the Children’s Hospital of Buenos Aires, the cohort of such procedures started in July, when the first fenestrated right heart by pass was performed, with the interposition of a homograft between the right atrial appendage and the main pulmonary artery. In the second patient, instead of placing a homograft, the APA was achieved with the patient’s own pulmonary root harvested from the outflow tract of the right ventricle. These techniques were soon replaced in 1978 with the development of the direct valveless posterior APA. Since the very beginning the principle was that the right atrium only functions as a pathway rather than a pump (reason why no inferior vena cava valves were ever used), and the diastolic properties of the systemic ventricle regulate the only real “pump” of this system. The late hemodynamic problems inherent of the APA diminished with modern surgical techniques like the lateral tunnel (LT) or the extracardiac conduit (EC). In spite of the improvement in prognosis and quality of life that the modern techniques have brought for univentricular hearts (UH), with the passing of time, deterioration of this system is frequently seen, due to chronic low cardiac output, elevated central venous pressure making heart transplantation the final stage of treatment. Progressive increase in pulmonary vascular resistances and ventricular dysfunction result in a decline in quality of life and survival. However, the timing of this occurrence is variable, and many survivors enjoy today a satisfactory clinical status. The challenge is to develop a better solution for UH, but in the mean time the Fontan Kreutzer palliation represents the best and only surgical option. It is undoubtedly one of the triumphs of cardiac surgery in congenital heart disease.
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spelling pubmed-38668022014-01-07 Reflections on Five Decades of the Fontan Kreutzer Procedure Kreutzer, Christián Kreutzer, Jacqueline Kreutzer, Guillermo O. Front Pediatr Pediatrics The first successful total right heart bypass via atriopulmonary anastomosis (APA) were reported in 1971 for patients with tricuspid atresia. At the Children’s Hospital of Buenos Aires, the cohort of such procedures started in July, when the first fenestrated right heart by pass was performed, with the interposition of a homograft between the right atrial appendage and the main pulmonary artery. In the second patient, instead of placing a homograft, the APA was achieved with the patient’s own pulmonary root harvested from the outflow tract of the right ventricle. These techniques were soon replaced in 1978 with the development of the direct valveless posterior APA. Since the very beginning the principle was that the right atrium only functions as a pathway rather than a pump (reason why no inferior vena cava valves were ever used), and the diastolic properties of the systemic ventricle regulate the only real “pump” of this system. The late hemodynamic problems inherent of the APA diminished with modern surgical techniques like the lateral tunnel (LT) or the extracardiac conduit (EC). In spite of the improvement in prognosis and quality of life that the modern techniques have brought for univentricular hearts (UH), with the passing of time, deterioration of this system is frequently seen, due to chronic low cardiac output, elevated central venous pressure making heart transplantation the final stage of treatment. Progressive increase in pulmonary vascular resistances and ventricular dysfunction result in a decline in quality of life and survival. However, the timing of this occurrence is variable, and many survivors enjoy today a satisfactory clinical status. The challenge is to develop a better solution for UH, but in the mean time the Fontan Kreutzer palliation represents the best and only surgical option. It is undoubtedly one of the triumphs of cardiac surgery in congenital heart disease. Frontiers Media S.A. 2013-12-18 /pmc/articles/PMC3866802/ /pubmed/24400290 http://dx.doi.org/10.3389/fped.2013.00045 Text en Copyright © 2013 Kreutzer, Kreutzer and Kreutzer. http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Kreutzer, Christián
Kreutzer, Jacqueline
Kreutzer, Guillermo O.
Reflections on Five Decades of the Fontan Kreutzer Procedure
title Reflections on Five Decades of the Fontan Kreutzer Procedure
title_full Reflections on Five Decades of the Fontan Kreutzer Procedure
title_fullStr Reflections on Five Decades of the Fontan Kreutzer Procedure
title_full_unstemmed Reflections on Five Decades of the Fontan Kreutzer Procedure
title_short Reflections on Five Decades of the Fontan Kreutzer Procedure
title_sort reflections on five decades of the fontan kreutzer procedure
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866802/
https://www.ncbi.nlm.nih.gov/pubmed/24400290
http://dx.doi.org/10.3389/fped.2013.00045
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