Fontan conversion with arrhythmia surgery.
OBJECTIVE
Hemodynamic abnormalities and refractory atrial arrhythmias in patients late after the Fontan operation result in significant morbidity and mortality. We reviewed our experience with Fontan conversion and concomitant arrhythmia surgery.


METHODS
Between January 1996 and February 2004, 16 patients underwent Fontan conversion and arrhythmia surgery. Mean age at the initial Fontan operation was 5.1+/-3.5 (range: 2-15) years and mean age at Fontan conversion was 17.0+/-5.8 (range: 6-30). The initial Fontan operations were atriopulmonary connections in 14 patients, extracardiac lateral tunnel in 1, and intracardiac lateral tunnel in 1. The types of arrhythmia included atrial flutter in 10 patients and atrial fibrillation in 3. Fontan conversion operation was performed with intracardiac lateral tunnel in 5 patients and extracardiac conduit in 11. Arrhythmia surgery included isthmus cryoablation in 10 patients and right-sided maze in 3.


RESULTS
There has been no mortality. At Fontan conversion operation, 7 patients required permanent pacemaker. All patients have improved to New York Heart Association class I or II. With a mean follow-up of 26.9+/-30.6 (range:1-87) months, 16 patients had sinus rhythm, 2 patients had transient atrial flutter which was well controlled, and 2 patients required permanent pacemaker during follow-up.


CONCLUSIONS
Fontan conversion with concomitant arrhythmia surgery and permanent pacemaker placement is safe, improves New York Heart Association functional class, and has a low incidence of recurrent arrhythmias. In most patients, concomitant permanent pacemakers are needed.
Kim
Woong-Han
WH
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu Seoul 110-799, Korea.
Lim
Hong Gook
HG
Lee
Jeong Ryul
JR
Rho
Joon Ryang
JR
Bae
Eun Jung
EJ
Noh
Chung Il
CI
Yoon
Yong Soo
YS
Kim
Yong Jin
YJ
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001282:Atrial Flutter / Q000209:etiology / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006325:Heart Atria / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000209:etiology; D011504:Protein-Losing Enteropathies / Q000150:complications / Q000601:surgery; D011655:Pulmonary Embolism / Q000150:complications / Q000601:surgery; D012086:Reoperation; D016896:Treatment Outcome