Volume: 3 Issue: 1
Year: 2015, Page: 21-23,
Introduction:The Fontan operation is usually the final palliative procedure in patients with niventricular heart. The objectives of this study were firstly to describe the clinical and hemodynamic characteristics of a group of patients with univentricular physiology who had previously been palliated with a right modified Blalock Taussig's Shunt, Bidirectional Glenn Shunt and secondly to identify the risk factors that can influence post-operative outcomes after Fontan operation.
Materials and Methods: A retrospective analysis of 20 patients who underwent Fontan operation between January 2005 to January 2014 was conducted. Clinical characteristics, catheterization data, type and duration of surgery were reviewed and analysed as predictors of post-operative outcome.
Results: We operated 20 cases out of which 14 were males and 6 were females. The majority of the patients (10) were in the age group of 11-20 years. The diagnosis included double outlet right ventricle (DORV) 5 patients, ventricular septal defect with pulmonary stenosis 5 patients, transposition of great arteries (TGA) 3 patients, tricuspid atresia (TA) 6 patients and double inlet left ventricle with pulmonary stenosis (DILV, PS) 1 patient. Out of these, 4 patients were palliated with right modified Blalock-Taussig (BT) shunt, and 6 patients with Glenn Shunt. The rest were for the direct Fontan procedure. Two patients died during the postoperative period.
Conclusion: The performance of hemodynamic study before Fontan operation made it possible to select high risk patients for surgery. Fontan operation showed dramatic improvements in symptoms and saturations.
Keywords: Fontan procedure, Univentricular heart, Cardiac catheterization
1. Rodbard S and Wagner D. Bypassing the right ventricle. Proc Soc Exp Biol Med 1949;71:69.
2. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax 1971;26:240–8.
3. Kreutzer G, Galindez E, Bono H, De Palma C, Laura JP. An operation for the correction of tricuspid atresia. J Thorac Cardiovasc Surg 1973;66:613–21.
4. Lemler MS, Scott WA, Leonard SR, Stromberg D, Ramaciotti C. Fenestration improves clinical outcome of the fontan procedure: a prospective, randomized study. Circulation 2002; 105: 207- 12.
5. deLeval MR, Kilner P, Gewillig M, Bull C. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. J ThoracCardiovascSurg 1988;96:682–95.
6. Bradley SM, Mosca RS, Hennein HA, Crowley DC, Kulik TJ, BoveEL. Bidirectional superior cavopulmonary connection in young infants. Circulation 1996;94:II5–11.
7. Norwood WI, Jacobs ML. Fontan's procedure in two stages. Am J Surg 1993;166:548–51.
8. Salim MA, Case CL, Sade RM, Watson DC, Alpert BS, DiSessa TG. Pulmonary/systemic flow ratio in children after cavopulmonary anastomosis. J Am Coll Cardiol. 1995; 25:735- 8.
9. Nicoson SC, Steven JM. Anesthesia for the patient with a single ventricle. En: Andropoulos D.B., Stayer S.A., Russell I.A., editors. Anesthesia for congenital heart disease. Malden: Blackwell Futura; 2005. 365.
10. Gentles TL, Mayer JE, Gauvreau K, Newburger JW, Lock JE, Kupferschmid JP, et al. Fontan operation in five hundred consecutive patients: factors influencing early and late outcome. J ThoracCardiovasc Surg. 1997; 114:376-91.
11. Driscoll DJ, Offord KP, Feldt RH, Schaff HV, Puga FJ, Danielson GK. Five-to-fifteen-year follow-up after Fontan operation. Circulation. 1992; 85:469-96.
12. Hirsch JC, Goldberg C, Bove EL, Salehian S, Lee T, Ohye RG, et al. Fontan operation in the current era. A 15-year single institution experience. Ann Surg 2008; 248:402-10.
13. Uemura H, Yagihara T, Kawashima Y, Yamamoto F, Nishigaki K, Matsuki O, et al. What factors affect ventricular performance after a Fontan-type operation?. J Thorac Cardiovasc Surg. 1995; 110:405-15.
14. Kaulitz R, Ziemer G, Luhmer I, Kallfelz H-C. Modified Fontan operation in functionally univentricular hearts: preoperative risk factors and intermediate results. J Thorac Cardiovasc Surg. 1996; 112:658-64.
Prabhu A, Dixit MD, Gan MD, Manvi V. A retrospective analysis of Fontan procedure and its sequence in tertiary care teaching hospital in southern India. Perspectives in medical research 2015;3:21-23.