Right atrioventricular extracardiac conduit as a fontan modification: late results.
BACKGROUND
The right ventricle, when incorporated in the Fontan circulation, might enlarge and function as a pump to the pulmonary circulation. Experience has shown that over the long-term, this operation can be associated with major difficulties.


METHODS
The late results, (13+/-6 years) after right atrioventricular connection as a Fontan modification, were reviewed in 14 patients with tricuspid atresia (11), ventricular septal-defect with small right ventricle (2), and double inlet left ventricle (1) to assess the long-term survival, the right ventricular size, and the need and timing of reoperations. Operations used a valved conduit (7), a valveless Dacron (E.L. Bard, Haverhill, PA) tube (5) and a direct right atrium-right ventricle anastomosis (2).


RESULTS
Death occurred in 5 by 8+/-5 years. Conduit obstruction occurred in 10 by 9+/-3 years equally in patients with valved (6 of 7) compared to patients with valveless conduits (4 of 5) and irrespective of right ventricular size (3 of 4 with enlarged right ventricle versus 4 of 6 with small ventricle). Patients with direct atrioventricular anastomosis had no obstruction. Reoperation was performed in 9 but failed to relieve the obstruction in 4 because of external compression (4) with or without thrombosis (1).


CONCLUSIONS
Right atrioventricular connection as a Fontan modification can provide good early palliation, but is a poor long-term solution, as it is associated with a high incidence and difficulties in relieving the obstruction.
Dore
A
A
Grown-up Congenital Heart Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, England. annie.dore@sympatico.ca
Somerville
J
J
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000295:instrumentation / Q000379:methods*; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D011652:Pulmonary Circulation / Q000502:physiology; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D018785:Tricuspid Atresia / Q000503:physiopathology / Q000601:surgery; D016278:Ventricular Function, Right / Q000502:physiology
D011093:Polyethylene Terephthalates