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Modified fontan operation

Modifizierte Fontan-Operation

  • Main Topics: Present Progress and Surgical Practice in Congenital Heart Disease
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Abstract

From November 1988 to October 1991 30 patients underwent a total extracardiac right heart bypass for complex cardiac anomalies by means of bidirectional cavopulmonary anastomosis and interposition of a conduit from the inferior vena cava to the pulmonary artery. Mean age at surgery was 6.4 years and mean weight 19.2 kg. There was 1 hospital death (3%) due to a borderline indication for a Fontan operation. 2 patients had further surgery: In 1 the repair was taken down due to the stenosis of the left pulmonary artery and the patient was left with a bidirectional cavopulmonary anastomosis only, the second patient required a revision of the cavopulmonary anastomosis due to a stenosis of the superior vena cavaright pulmonary artery junction. There were no late deaths and the survivors are in good clinical condition a mean of 15.1 months after the operation. We propose this technique as an alternative surgical option in candidates for a Fontan operation in whom atrial septation is hazardous including those with 1) hypoplasia or atresia of the left atrio-ventricular valve, 2) common atrioventricular valve, 3) anomalies of systemic and/or pulmonary venous return, or 4) auricular juxtaposition.

Zusammenfassung

Zwischen November 1988 und Oktober 1991 wurde bei 30 Patienten mittels bidirektionaler kavopulmonaler Anastomose und Conduitinterposition (zwischen V. cava inferior und Pulmonalarterie) ein totaler extrakardialer Rechtsherzbypass angelegt. Das mittlere Patientenalter zum Zeitpunkt der Operation betrug 6,4 Jahre, das mittlere Körpergewicht 19,2 kg. 1 Patient (3%) verstarb perioperativ bei grenzwertiger Operationsindikation. Bei 2 Patienten waren weitere Eingriffe notwendig: Imal ein Fontan-Take-down infolge einer linksseitigen Pulmonalarterienstenose— der Patient verblieb mit einer bidirektionalen kavopulmonalen Anastomose. Beim 2. Patienten erforderte eine Stenose die Revision der kavopulmonalen Anastomose. Alle überlebenden Patienten sind in guter klinischer Verfassung, im Mittel 15.1 Monate nach der Operation. Spättodesfälle traten nicht auf. Wir empfehlen diese Methode als chirurgische Alternative für jene Fontan-Operationskandidaten, bei denen eine intraatriale Tunnelierung bzw. Septierung mit einem höheren Risiko verbunden ist: 1. bei Hypoplasie oder Atresie der linken Atrioventrikularklappe, 2. bei gemeinsamer Atrioventrikularklappe. 3. bei Anomalien des system- oder pulmonalvenösen Rückflusses bei Herzohr-Juxtaposition.

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Authors and Affiliations

  1. Division of Surgery, Department of Pediatric Cardiology, Children's Hospital “Bambino Gesú”, Rome, Italy

    A. Amodeo, F. S. Iorio, A. Giamberti & C. Marcelletti

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  1. A. Amodeo
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  2. F. S. Iorio
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  3. A. Giamberti
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  4. C. Marcelletti
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Amodeo, A., Iorio, F.S., Giamberti, A. et al. Modified fontan operation. Acta Chir Austriaca 25, 89–91 (1993). https://doi.org/10.1007/BF02602134

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  • DOI: https://doi.org/10.1007/BF02602134

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