Early reduction of the volume work of the single ventricle: the hemi-Fontan operation.
BACKGROUND
In hearts with a functional single ventricle, cavity volume and myocardial muscle mass increase as a consequence of the excessive volume work associated with parallel pulmonary and systemic circulations. The hemi-Fontan operation was conceived as a means of accomplishing early reduction of the volume work of the single ventricle.


METHODS
All patients presenting in infancy with single-ventricle physiology were managed by early hemi-Fontan operation in anticipation of a subsequent completion Fontan operation. Between May 1989 and August 1995, 400 patients less than 2 years of age underwent hemi-Fontan operations. Mean age at operation was 8.5 months (range, 2 months to 24 months). The hemi-Fontan operation included association of superior vena(e) cava(e) with the branch pulmonary arteries, augmentation of the central pulmonary arteries, occlusion of the inflow of the superior vena cava into the right atrium, and elimination of other sources of pulmonary blood flow.


RESULTS
Operative mortality ( < 30 days) was 31 of 400 patients (7.8%). For the last 200 patients, operative mortality was 8 of 200 (4.0%). Younger age at operation was not an independent risk factor for operative mortality. Urgent operation in the presence of a hemodynamic burden requiring concomitant procedures was associated with increased mortality.


CONCLUSIONS
The hemi-Fontan operation can be accomplished with low operative mortality in young patients, achieving early reduction of the volume work of the single-ventricle heart.
Jacobs
M L
ML
Department of Surgery, Deborah Heart and Lung Center, Browns Mills, New Jersey 08015, USA.
Rychik
J
J
Rome
J J
JJ
Apostolopoulou
S
S
Pizarro
C
C
Murphy
J D
JD
Norwood
W I
WI
D000367:Age Factors; D001775:Blood Circulation; D002675:Child, Preschool; D004630:Emergencies; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods*; D006325:Heart Atria / Q000601:surgery; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery; D007223:Infant; D016015:Logistic Models; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology; D011651:Pulmonary Artery / Q000601:surgery; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D014683:Vena Cava, Superior / Q000601:surgery