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Conversion of the failed Fontan circulation

Published online by Cambridge University Press:  10 January 2006

Carl L. Backer ,
Barbara J. Deal ,
Constantine Mavroudis ,
Wayne H. Franklin  and
Robert D. Stewart
Carl L. Backer
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Barbara J. Deal
Affiliation:
Division of Cardiology, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Constantine Mavroudis
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Wayne H. Franklin
Affiliation:
Division of Cardiology, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Robert D. Stewart
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Extract

Many patients with a functional univentricular heart were treated in the 1970s and 1980s, using an atriopulmonary connection to create the Fontan circulation.1–3 Although this procedure, in many patients, was initially successful, and provided arterial saturations of oxygen close to normal, as these patients were followed over the years, in some cases they developed significant complications. One complication of the atriopulmonary connection is progressive right atrial dilation, which leads to atrial arrhythmias, such as atrial flutter or fibrillation.4,5 The combination of these two problems leads to low cardiac output, diminished quality of life, and poor categorization within the classification of the New York Heart Association. This, and other issues, has led most centres to abandon the atriopulmonary connection as a means of creating the Fontan circulation in favour of the lateral tunnel with cavopulmonary connections,6 or the extracardiac conduit.7

Keywords

Functionally univentricular heartarrhythmiascardiac failuredouble inlet ventricleatrioventricular valvar atresia
Type
Research Article
Information
Cardiology in the Young , Volume 16 , Supplement S1: Controversies and Challenges in the Management of the Functionally Univentricular Heart , February 2006 , pp. 85 - 91
Copyright
© 2006 Cambridge University Press

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References

Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.Google Scholar
Fontan F, Deville C, Quaegebeur J, et al. Repair of tricuspid atresia in 100 patients. J Thorac Cardiovasc Surg 1983; 85: 647–660.Google Scholar
Kreutzer G, Galindez E, Bono H, De Palma C, Laura JP. An operation for the correction of triucspid atresia. J Thorac Cardiovasc Surg 1973; 66: 613–621.Google Scholar
Peters NS, Somerville J. Arrhythmias after the Fontan procedure. Br Heart J 1992; 68: 199–204.Google Scholar
Gelatt M, Hamilton RM, McCrindle BW, et al. Risk factors for atrial tachyarrhythmias after the Fontan operation. J Am Coll Cardiol 1994; 24: 1735–1741.Google Scholar
de Leval MR, Kilner P, Gewillig M, Bull C. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg 1988; 96: 682–695.Google Scholar
Marcelletti C, Corno A, Giannico S, Marino B. Inferior vena cava-pulmonary artery extracardiac conduit. A new form of right heart bypass. J Thorac Cardiovasc Surg 1990; 100: 228–232.Google Scholar
Kao JM, Alejos JC, Grant PW, Williams RG, Shannon KM, Laks H. Conversion of atriopulmonary to cavopulmonary anastomosis in management of late arrhythmias and atrial thrombosis. Ann Thorac Surg 1994; 58: 1510–1514.Google Scholar
Mavroudis C, Backer CL, Deal BJ, Johnsrude CL. Fontan conversion to cavopulmonary connection and arrhythmia circuit cryoablation. J Thorac Cardiovasc Surg 1998; 115: 547–556.Google Scholar
Kreutzer J, Keane JF, Lock JE, et al. Conversion of modified Fontan procedure to lateral atrial tunnel cavopulmonary anastomosis. J Thorac Cardiovasc Surg 1996; 111: 1169–1176.Google Scholar
Marcelletti CF, Hanley FL, Mavroudis C, et al. Revision of previous Fontan connections to total extracardiac cavopulmonary anastomosis: A multicenter experience. J Thorac Cardiovasc Surg 2000; 119: 340–346.Google Scholar
Theodoro DA, Danielson GK, Porter CJ, Warnes CA. Right-sided maze procedure for right atrial arrhythmias in congenital heart disease. Ann Thorac Surg 1998; 65: 149–153.Google Scholar
Cox JL, Boineau JP, Schuessler RB, Jaquiss RD, Lappas DG. Modification of the maze procedure for atrial flutter and atrial fibrillation. I. Rationale and surgical results. J Thorac Cardiovasc Surg 1995; 110: 473–484.Google Scholar
Mavroudis C, Stewart RD, Backer CL, Deal BJ, Young L, Franklin WH. Atrioventricular valve procedures with repeat Fontan operations: influence of valve pathology, ventricular function, and arrhythmias on outcome. Ann Thorac Surg 2005; 80: 29–36.Google Scholar
Morales DL, DiBardino DJ, Braud BE, et al. Salvaging the failing Fontan: lateral tunnel versus extracardiac conduit. Presented, 41st Annual Meeting Society of Thoracic Surgeons, Tampa, January 24–26, 2005.Google Scholar
Weinstein S, Cua C, Chan D, Davis JT. Outcome of symptomatic patients undergoing extracardiac Fontan conversion and cryoablation. J Thorac Cardiovasc Surg 2003; 126: 529–536.Google Scholar
Sheikh AM, Tang AT, Roman K, et al. The failing Fontan circulation: successful conversion of atriopulmonary connections. J Thorac Cardiovasc Surg 2004; 128: 60–66.Google Scholar
Balaji S, Johnson TB, Sade RM, Case CL, Gillette PC. Management of atrial flutter after the Fontan procedure. J Am Coll Cardiol 1994; 23: 1209–1215.Google Scholar
Vitullo DA, DeLeon SY, Berry TE, et al. Clinical improvement after revision in Fontan patients. Ann Thorac Surg 1996; 61: 1797–1804.Google Scholar
McElhinney DB, Reddy VM, Moore P, Hanley FL. Revision of previous Fontan connections to extracardiac or intraatrial conduit cavopulmonary anastomosis. Ann Thorac Surg 1996; 62: 1276–1282.Google Scholar
Scholl FG, Alejos JC, Laks H. Revision of the traditional atriopulmonary Fontan connection. Adv Card Surg 1997; 9: 217–227.Google Scholar
van Son JAM, Mohr FW, Hambsch J, Schneider P, Hess H, Haas GS. Conversion of atriopulmonary or lateral atrial tunnel cavopulmonary anastomosis to extracardiac conduit Fontan modification. Eur J Cardiothorac Surg 1999; 15: 150–157.Google Scholar
Bernstein D, Naftel D, Chin C, et al. Outcome of listing for cardiac transplantation for failed Fontan: a follow-up multi-institutional study. Pediatric Heart Transplant Study Group. Presented, 24th Annual International Society for Heart and Lung Transplantation Scientific Meeting, San Francisco, April 21–24, 2004.Google Scholar
Carey JA, Hamilton JR, Hilton CJ, et al. Orthotopic cardiac transplantation for the failing Fontan circulation. Eur J Cardiothorac Surg 1998; 14: 7–13.Google Scholar
Michielon G, Parisi F, Squitieri C, et al. Orthotopic heart transplantation for congenital heart disease: an alternative for high-risk Fontan candidates? Circulation 2003; 108 (Suppl 1): II-140–II-149.Google Scholar
Mitchell MB, Campbell DN, Ivy D, et al. Evidence of pulmonary vascular disease after heart transplantation for Fontan circulation failure. J Thorac Cardiovasc Surg 2004; 128: 693–702.Google Scholar
Mitropoulos FA, Laks H, Neelankavil J, et al. Orthotopic heart transplantation in patients with Fontan circulation. Presented, 41st Annual Meeting Society of Thoracic Surgeons, Tampa, January 24–26, 2005.Google Scholar
Jayakumar KA, Addonizio LJ, Kichuk-Chrisant MR, et al. Cardiac transplantation after the Fontan or Glenn procedure. J Am Coll Cardiol 2004; 44: 2065–2072.Google Scholar
Ringewald JM, Gidding SS, Crawford SE, Backer CL, Mavroudis C, Pahl E. Nonadherence is associated with late rejection in pediatric heart transplant recipients. J Pediatr 2001; 139: 75–78.Google Scholar