The Fontan-operation: from intra- to extracardiac procedure.
OBJECTIVE
For treatment of univentricular heart, the Fontan operation has been established as the definitive palliation. The current controversy is mainly based on the high incidence of arrhythmias after an intra-atrial lateral tunnel Fontan operation.


METHODS
From January 1995 until April 2002, 46 children underwent a Fontan-type operation with or without a small fenestration. In 33 patients (group I) an intracardiac tunnel and in 13 patients (group II) an extracardiac conduit procedure was performed.


RESULTS
There was no perioperative mortality. All patients showed postoperative a significant increase of arterial oxygen saturation, from 76 to 86% after surgery with fenestration, or to 90.5% without fenestration respectively. In patients with fenestration procedure, the saturation rose to 90% after closure of fenestrations 9 to 12 months after operation.


CONCLUSIONS
Modified Fontan operations can be performed in normothermia on the beating heart with acceptable mortality. The extracardiac conduit Fontan procedure has the benefits of less surgical injury and a higher intraoperative flexibility.
Kuroczynski
W
W
Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University, Langenbeckstrasse 1, D-55131 Mainz, Germany. kuroczynski@uni-mainz.de
Kampmann
C
C
Choi
Y-H
YH
Pruefer
D
D
Singelmann
J
J
Huth
R
R
Schmid
F-X
FX
Heinemann
M
M
Oelert
H
H
D000293:Adolescent; D000328:Adult; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D008297:Male; D010100:Oxygen / Q000097:blood
D010100:Oxygen