Bedah Fontan dan Permasalahannya
Abstract
Ketika bedah Fontan baru diperkenalkan pada tahun 1970, para ahli menaruh harapan besar. Mereka beranggapan sirkulasi Fontan merupakan ide besar, yang mampu mengatasi berbagai variasi penyakit jantung bawaan (PJB) dengan fisiologi ventrikel tunggal. Tetapi 20 tahun kemudian, mulailah Fontan dkk mengenali kelemahan prosedur yang ia inisiasi. Dari evaluasi jangka panjang yang ia lakukan terbukti bahwa, meskipun pada bedah Fontan yang sempurna, dalam jangka panjang kapasitas fungsional pasen menurun, dan ini tak berkaitan dengan masalah lain kecuali sirkulasi Fontan.Beberapa penelitian jangka menengah dan jangka panjang lainnya juga menemukan berbagai masalah, misalnya disfungsi hati, gangguan koagulopati yang berakibat tromboemboli, protein loosing enteropathy(PLE) yang menimbulkan hipoalbuminemia dengan segala akibatnya, aritmia, obstruksi pada jalur Fontan, fistula arteriovenous pulmonal dan lain-lain. Semua masalah ini tentu saja mengakibatkan berkurangnya kesintasan pasen-pasen tersebut.
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References
Fontan F, Kirklin KW, Fernandez G, et al. Outcome after a “perfect” Fontan operation. Circulation 1990;81:1520–36.
Kaulitz R, Luhmer I, Bergmann F, et al. Sequelae after modi-fied Fontan operation: postoperative haemodynamic data and organ function. Heart 1997;78:154–9.
Cromme-Dijkhuis AH, Hess J, Hählen K, et al. Specific se-quelae after Fontan operation at mid- and long-term follow-up. J Thorac Cardiovasc Surg.1993;106:1126–32.
Van Noewenhuizen RC, Peters M, Lubbers LJ, Trip MD, Tijssen JGP, Mulder BJM. Abnormalities in liver function and coagu-lation profile following the Fontan procedure. Heart 1999’ 82’ 40-46
Ravn, HB, Hjortdal VE. Stenborg EV, Emmertsen K, Kromann O, Pedersen J, Sorensen KE. Increase platelet reactivity and sig-nificant changes in coagulation markers afer cavopulmonary connection. Heart 2001;85;61-65
Nelson DL, Blaese RM, Strober W, et al. Constrictive peri-carditis, intestinal lymphangiectasia, and reversible immuno-logic deficiency. J Pediatr 1975;86:548–54.
Davidson JD, Waldmann TA, Goodman DS, et al. Protein-losing gastroenteropathy in congestive heart failure. Lancet 1961;i:899–902.
Strober W, Cohen LS,Waldmann TA, et al.Tricuspid regurgita-tion. A newly recognized cause of protein-losing enteropathy, lymphocytopenia and immunologic deficiency. Am J Med 1968;44:842–50.
Feldt RH, Driscoll DJ, Offord KP, et al. Protein-losing enter-opathy after the Fontan operation. J. Thorac Cardiovasc Surg 1996;112:672–80.
Bull K. The Fontan procedure: lessons from the past. Heart 1998;79;213-214
Kinmonth JB, Sharpey-Schafer EP. Pressure waves in the hu-man thoracic duct. J Physiol 1959;145(3P):556-61.
Drake RE, Abbott RD. Effect of increased neck vein pressure on intestinal lymphatic pressure in awake sheep. Am J Physiol 1992;262:R892–4.
Atrial Fibrillation Investigators. Risk factors for stroke and effi-cacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch In-tern Med 194;154:1449–57.
Rosenthal DN, Friedman AH, Kleinman CS, et al. Throm-boembolic complications after Fontan operations. Circulation 1995;92(suppl II):287–93.
Porter CJ, Battiste CE, Humes RA et al. Risk factors for su-praventricular tachyarrhythmias after Fontan procedure for tri-cuspid atresia. Am Heart J. 112;645, 1986 (abstract).
Pearl JM, Laks H, Stein DG et al. Total Caopulmonary anasto-mosis versus conventional modified Fontan procedures. Ann Thorac surg. 52;189, 1991
Balaji S, Gewillig M, Bull C et al. Arrhythmias after the Fontan procedure. Comparation of total cavopulmonary connection and atriopulmoanry connection. Circulation 84 (Suppl); 162,1991
Kaulitz R, Luhmer I, Bergmann F, et al. Sequelae after modi-fied Fontan operation: postoperative haemodynamic data and organ function. Heart 1997;78:154–9.
Cromme-Dijkhuis AH, Hess J, Hählen K, et al. Specific se-quelae after Fontan operation at mid- and long-term follow-up. J Thorac Cardiovasc Surg.1993;106:1126–32.
Van Noewenhuizen RC, Peters M, Lubbers LJ, Trip MD, Tijssen JGP, Mulder BJM. Abnormalities in liver function and coagu-lation profile following the Fontan procedure. Heart 1999’ 82’ 40-46
Ravn, HB, Hjortdal VE. Stenborg EV, Emmertsen K, Kromann O, Pedersen J, Sorensen KE. Increase platelet reactivity and sig-nificant changes in coagulation markers afer cavopulmonary connection. Heart 2001;85;61-65
Nelson DL, Blaese RM, Strober W, et al. Constrictive peri-carditis, intestinal lymphangiectasia, and reversible immuno-logic deficiency. J Pediatr 1975;86:548–54.
Davidson JD, Waldmann TA, Goodman DS, et al. Protein-losing gastroenteropathy in congestive heart failure. Lancet 1961;i:899–902.
Strober W, Cohen LS,Waldmann TA, et al.Tricuspid regurgita-tion. A newly recognized cause of protein-losing enteropathy, lymphocytopenia and immunologic deficiency. Am J Med 1968;44:842–50.
Feldt RH, Driscoll DJ, Offord KP, et al. Protein-losing enter-opathy after the Fontan operation. J. Thorac Cardiovasc Surg 1996;112:672–80.
Bull K. The Fontan procedure: lessons from the past. Heart 1998;79;213-214
Kinmonth JB, Sharpey-Schafer EP. Pressure waves in the hu-man thoracic duct. J Physiol 1959;145(3P):556-61.
Drake RE, Abbott RD. Effect of increased neck vein pressure on intestinal lymphatic pressure in awake sheep. Am J Physiol 1992;262:R892–4.
Atrial Fibrillation Investigators. Risk factors for stroke and effi-cacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch In-tern Med 194;154:1449–57.
Rosenthal DN, Friedman AH, Kleinman CS, et al. Throm-boembolic complications after Fontan operations. Circulation 1995;92(suppl II):287–93.
Porter CJ, Battiste CE, Humes RA et al. Risk factors for su-praventricular tachyarrhythmias after Fontan procedure for tri-cuspid atresia. Am Heart J. 112;645, 1986 (abstract).
Pearl JM, Laks H, Stein DG et al. Total Caopulmonary anasto-mosis versus conventional modified Fontan procedures. Ann Thorac surg. 52;189, 1991
Balaji S, Gewillig M, Bull C et al. Arrhythmias after the Fontan procedure. Comparation of total cavopulmonary connection and atriopulmoanry connection. Circulation 84 (Suppl); 162,1991
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How to Cite
Rahajoe, A. (1). Bedah Fontan dan Permasalahannya. Indonesian Journal of Cardiology, 28(5), 317-319. https://doi.org/10.30701/ijc.v28i5.216
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