Publication: Cirugía de Fontan en nuestro medio: resultados de un centro nacional de referencia
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2018-04-05
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Universidad Complutense de Madrid
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Abstract
La cirugía de Fontan es una técnica quirúrgica paliativa que surgió para tratar las malformaciones cardiacas con fisiología univentricular, en las que no es posible la reparación biventricular. En la fisiología univentricular, las circulaciones sistémica y pulmonar constan de un solo ventrículo como bomba para las circulaciones sistémica y pulmonar. La técnica de Fontan consiste en separar las circulaciones sistémica y pulmonar, de forma que el retorno venoso proveniente de las venas cavas pase directamente al pulmón sin pasar por el corazón. El ventrículo único soporta únicamente la circulación sistémica. Fue descrita en 1971 por Fontan y Kreutzer. Para redirigir el flujo sanguíneo de las venas cavas al pulmón se necesitan presiones más altas en el sistema venoso sistémico y presiones bajas en el circuito pulmonar. Además, la pérdida de la pulsatibilidad del flujo en las arterias pulmonares favorece el aumento de las resistencias pulmonares. El ventrículo único maneja el gasto sistémico con volúmenes más bajos que en condiciones normales al depender la precarga del retorno venoso pulmonar. El gasto cardiaco se vería afectado ante cualquier daño en los elementos que intervienen en este sistema: conexiones cavo-pulmonares, arteria pulmonar y ramas pulmonares, red vascular pulmonar, venas pulmonares y sus conexiones auriculares...
Fontan surgery is a palliative surgical technique to treat cardiac malformations with univentricular physiology, in which biventricular repair is not possible. In univentricular physiology, the systemic and pulmonary circulations use a single ventricle as a pump for systemic and pulmonary circulations. This technique consists on separating the systemic and pulmonary circulations, so that the venous return from the cavas veins flows directly to the lung without passing through the heart. The single ventricle supports only the systemic circulation. It was described in 1971 by Fontan and Kreutzer. Reducing blood flow from the vena cava to the lung requires higher pressures in the systemic venous system and lower pressures in the pulmonary circuit. In addition, the loss of pulsatibility of the flow in the pulmonary arteries favors the increase of the pulmonary resistances. The single ventricle drives systemic expenditure at lower volumes than under normal conditions, depending on the preload of pulmonary venous return. The cardiac output would be affected by any damage to the elements involved in this system: cavo-pulmonary connections, pulmonary artery and pulmonary branches, pulmonary vascular network, pulmonary veins and their atrial connections...
Fontan surgery is a palliative surgical technique to treat cardiac malformations with univentricular physiology, in which biventricular repair is not possible. In univentricular physiology, the systemic and pulmonary circulations use a single ventricle as a pump for systemic and pulmonary circulations. This technique consists on separating the systemic and pulmonary circulations, so that the venous return from the cavas veins flows directly to the lung without passing through the heart. The single ventricle supports only the systemic circulation. It was described in 1971 by Fontan and Kreutzer. Reducing blood flow from the vena cava to the lung requires higher pressures in the systemic venous system and lower pressures in the pulmonary circuit. In addition, the loss of pulsatibility of the flow in the pulmonary arteries favors the increase of the pulmonary resistances. The single ventricle drives systemic expenditure at lower volumes than under normal conditions, depending on the preload of pulmonary venous return. The cardiac output would be affected by any damage to the elements involved in this system: cavo-pulmonary connections, pulmonary artery and pulmonary branches, pulmonary vascular network, pulmonary veins and their atrial connections...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Pediatría, leída el 29/06/2017