title: Fontan conversion with arrhythmia surgery.
abstract: 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.
authors.affiliation: 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.
authors.forename: Woong-Han
authors.initials: WH
authors.lastname: Kim
authors.forename: Hong Gook
authors.initials: HG
authors.lastname: Lim
authors.forename: Jeong Ryul
authors.initials: JR
authors.lastname: Lee
authors.forename: Joon Ryang
authors.initials: JR
authors.lastname: Rho
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Bae
authors.forename: Chung Il
authors.initials: CI
authors.lastname: Noh
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Yoon
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Kim
mesh_terms: 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