Abstract
Patients (PTS) with univentricular heart (UH) and outlet foramen (OF) obstruction have a greater surgical mortality than PTS with UH without OF obstruction. To determine the exact mortality and to attempt to delineate predictors of outcome we examined the records of all PTS with UH and OF obstruction operated upon at the Mayo Clinic from 1973 to 1983.
Of the 17 PTS identified, 12 had a modified Fontan procedure, 3 ventricular septation, 1 resection of the OF with a side to side aorta (AO) to main pulmonary artery (PA) anastomosis, and 1 transection of the main PA with a proximal PA to AO anastomosis and an AO to distal PA Gortex graft. Ten of the 17 PTS died within 72 hrs of operation. Mean age at operation was significantly greater (P<0.001) among survivors (14.3±2.0 yrs) than nonsurvivors (6.5±4.2 yrs). There was no difference in postoperative gradient across the OF, aortic crossclamp time or bypass time between the two groups. Survivors had a significantly lower gradient (P<0.01) across the OF measured at preop cath (39.6±19.9) than survivors (83.9±35.7). No PT with a gradient greater than 66 mm Hg survived. Survivors had significantly smaller (P<0.005) preoperative CT rations (0151±0.07) than nonvurvivors (0.61±0.05). No PT with more than 3 mm of J-point depression in any ECG lead survived.
UH with OF obstruction is a rare condition with a high surgical mortality. Mortality is related to age at operation and degree of OF obstruction, cardiomegaly and J-point depression.
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Barber, G., McGoon, D., Danielson, G. et al. SURGICAL REPAIR OF UNIVENTRICULAR HEART WITH OUTLET FORAMEN OBSTRUCTION. Pediatr Res 18 (Suppl 4), 118 (1984). https://doi.org/10.1203/00006450-198404001-00153
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DOI: https://doi.org/10.1203/00006450-198404001-00153