Modified Fontan operation for univentricular heart and complicated congenital lesions

Noninvasive evaluations of pulmonary circulation, cardiac function, and liver excreting rate at late follow-up following the modified Fontan operation

“…Since Fontan and Baudet [11] reported the first surgical repair of tricuspid atresia using valves between the right atrium and the main pulmonary artery and in the inferior vena cava in 1971, several alternative surgical procedures [4,5,12,t3] have been applied to tricuspid atresia and other complex cardiac anomalies. These modified Fontan procedures in patients with complex congenital heart diseases have brought great improvement in clinical status, but the morbidity and complications in these patients at long-term follow-up period remain high [1][2][3][4][5][6][7]. It seems that some of these patients would not have been classed as candidates according to the present criteria [17] of this procedure and some developed major organ dysfunctions at the late follow-up periods [15][16][17].…”

“…[1][2][3]. As experience with this procedure has accumulated, virtually all patients with functional single ventricle have been evaluated and the selection criteria have become more flexible [4][5][6]. Survival with good cardiac function is reported at relatively short periods following the Fontan procedure [5,6].…”

Fontan Operation and the Single Ventricle

“…They reasoned that "the indications for this procedure apply only to children who are sufficiently developed, without pulmonary hypertension." Fontan and Baudet initially performed this procedure in 3 patients with tricuspid atresia; 1 died shortly following the operation 6 Experimental evaluation of atrial function in the Fontan circuit suggested that atrial contraction is not essential for appropriate function. 7 Based on this hypothesis, Kawashima et al performed the first total cavopulmonary shunt bypassing the right atrium entirely.…”

Arterial Thromboembolism in the Pediatric Population

“…The Fontan principle is diversion of systemic venous return to the pulmonary arteries in univentricular hearts, and although the original procedure has been modified, the principle remains the same. [71][72][73] The perioperative mortality has declined dramatically over the years, however, morbidity and mortality still occur after the procedure; the majority of which are due to thromboembolic complications. 74,75 Furthermore, TEs may occur up to several years after the procedure.…”