This research by Sara Arrigoni analyzes the long-term complications in patients with a single-ventricle heart. The impact of surgical techniques was discussed, and the core of the thesis was the analysis of the evolution of this heart defect over time.
Chapter 1 provides an overview of univentricular physiology and the history of univentricular surgery. Following the first Fontan procedure, new techniques were developed to reduce complications, but long-term issues such as arrhythmias remain a challenge. A thorough analysis of the mechanisms behind long-term complications is essential to improve prognosis.
Chapter 2 compares two surgical techniques: the right atrial appendage tunnel and the Gore-Tex® tunnel. 73 patients were analyzed, but no difference was found in the risk of arrhythmias or survival. However, the right atrial appendage tunnel was found to have greater growth potential, which could be counterproductive.
In Chapter 3, 11 patients who developed pulmonary arteriovenous fistulas after a Kawashima procedure were analyzed. After reconnection of the hepatic veins, their oxygen saturation and condition significantly improved.
Chapter 4 discusses a multicenter study of patients with unbalanced atrioventricular septal defect. Survival and the likelihood of completing the Fontan procedure have improved. However, outcomes for patients with valve insufficiency were worse, indicating that valve repair is important.
Chapter 5 describes various surgical techniques for the Glenn procedure in patients with bilateral superior venae cavae. The best technique depends on the patient's specific anatomy.
Chapter 6 investigates blood flow distribution during cavopulmonary anastomosis surgeries. A redistribution of blood was observed, which helps protect the brain. More research is needed to identify predictive factors for failure.
Chapter 7 analyzes a 10-year follow-up of patients after a Fontan procedure using MRI scans. A decline in cardiac index was observed, indicating progressive failure of univentricular circulation within 10 years post-surgery.
MRI scans are recommended for a comprehensive evaluation of these patients.
