Tricuspid atresia surgery: Difference between revisions
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# Surgeons with training and expertise in congenital heart disease (CHD) should perform operations for single-ventricle anatomy or physiology. (Level of Evidence: C)}} | # Surgeons with training and expertise in congenital heart disease (CHD) should perform operations for single-ventricle anatomy or physiology. (Level of Evidence: C)}} | ||
===Surgical Interventions=== | |||
There are a number of interventional methods to address a tricuspid atresia. These include: | There are a number of interventional methods to address a tricuspid atresia. These include: | ||
* [[PGE1]] to maintain [[patent ductus arteriosus]] | * [[PGE1]] to maintain [[patent ductus arteriosus]] | ||
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===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]=== | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]=== | ||
# Lifelong follow-up is recommended for patients after a Fontan type of operation; this should include a yearly evaluation by a cardiologist with expertise in the care of adult congenital heart disease (ACHD) patients. (Level of Evidence: C)}} | # Lifelong follow-up is recommended for patients after a Fontan type of operation; this should include a yearly evaluation by a cardiologist with expertise in the care of adult congenital heart disease (ACHD) patients. (Level of Evidence: C)}} | ||
===ACC/AHA Guidelines - Recommendations for Surgery for Adults with Prior Fontan Repair (DO NOT EDIT)=== | |||
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===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]=== | |||
*Surgeons with training and expertise in CHD should perform operations on patients with prior Fontan repair for single-ventricle physiology. (Level of Evidence: C) | |||
* Reoperation after Fontan is indicated for the following: | |||
** Unintended residual atrial septal defect (ASD) that results in right-to-left shunt with symptoms and/or cyanosis not amenable to transcatheter closure. (Level of Evidence: C) | |||
** Hemodynamically significant residual systemic artery-to-pulmonary artery shunt, residual surgical shunt, or residual ventricle-to-pulmonary artery connection not amenable to transcatheter closure. (Level of Evidence: C) | |||
** Moderate to severe systemic atrioventricular (AV) valve regurgitation. (Level of Evidence: C) | |||
** Significant (greater than 30-mm Hg peak-to-peak) subaortic obstruction. (Level of Evidence: C) | |||
** Fontan pathway obstruction. (Level of Evidence: C) | |||
** Development of venous collateral channels or pulmonary arteriovenous malformation not amenable to transcatheter management. (Level of Evidence: C) | |||
** Pulmonary venous obstruction. (Level of Evidence: C) | |||
** Rhythm abnormalities, such as complete AV block or sick sinus syndrome, that require epicardial pacemaker insertion. (Level of Evidence: C) | |||
** Creation or closure of a fenestration not amenable to transcatheter intervention. (Level of Evidence: C) | |||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]=== | |||
* Reoperation for Fontan conversion (i.e., revision of an atriopulmonary connection to an intracardiac lateral tunnel, intra-atrial conduit, or extracardiac conduit) can be useful for recurrent atrial fibrillation or flutter without hemodynamically significant anatomic abnormalities. A concomitant Maze procedure should also be performed. (Level of Evidence: C) | |||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]=== | |||
* Heart transplantation may be beneficial for severe SV dysfunction or protein-losing enteropathy (PLE). (Level of Evidence: C)}} | |||
==References== | ==References== | ||
Revision as of 15:04, 2 October 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Keri Shafer, M.D. [2] Priyamvada Singh, MBBS [[3]]
Assistant Editor-In-Chief: Kristin Feeney, B.S. [[4]]
Overview
Surgery
ACC/AHA Guidelines - Recommendation for Surgical Options for Patients With Single Ventricle (DO NOT EDIT)
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Class I
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Surgical Interventions
There are a number of interventional methods to address a tricuspid atresia. These include:
- PGE1 to maintain patent ductus arteriosus
- Modified Blalock-Taussig shunt to maintain pulmonary blood flow by placing a Gortex conduit between the subclavian artery and the pulmonary artery.
- Cavopulmonary anastomosis (hemi-Fontan or bidirectional Glenn) to provide stable pulmonary flow
- Fontan procedure to redirect inferior vena cava and hepatic vein flow into the pulmonary circulation
ACC/AHA Guidelines - Recommendation for Evaluation and Follow-Up After Fontan Procedure (DO NOT EDIT)
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Class I
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ACC/AHA Guidelines - Recommendations for Surgery for Adults with Prior Fontan Repair (DO NOT EDIT)
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Class I
Class IIa
Class IIb
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