The extracardiac Fontan procedure.
The extracardiac modification of the Fontan procedure for complex single ventricle congenital cardiac disease is the latest attempt at improving on both the short-term and long-term results of this operation. This procedure differs from other modifications in that the inferior vena cava is detached from the heart and connected via a conduit to the pulmonary artery. It uses the fluid dynamic advantages of the cavopulmonary connection type of Fontan procedure but has other potential advantages as well. It is not necessary to cross-clamp the aorta to perform this procedure. Although quite a bit of prosthetic material is necessary to make the appropriate connections, none of this is exposed to the systemic circulation. Atrial flutter, a common early and late complication of other modifications of the Fontan procedure, appears to be less common with the extracardiac technique. The major disadvantages of this modification are the greater exposure of the venous pathway to potentially thrombogenic surfaces and the larger amount of prosthetic material involved in constructing the connection of the inferior vena cava to the pulmonary artery. Although the intermediate-term results with this procedure have been very favorable, issues that remain unresolved include the growth potential of the pathway, risk of late obstruction, and risk of atrial arrhythmias occurring late. Copyright 1998 by W.B. Saunders Company
Huddleston
Charles B.
CB
Department of Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO.