title: Fontan operation with a viable and growing conduit using pedicled autologous pericardial roll: serial changes in conduit geometry.
abstract: OBJECTIVE
  We sought to examine midterm results of the Fontan operation with an extracardiac conduit using pedicled autologous pericardial roll, with special attention to angiographic evaluation of serial changes in conduit geometry.
  
  
  METHODS
  Of 202 patients subjected to the Fontan operation since 1996, the conduit was used in 28 patients who had intact pericardium. We retrospectively reviewed a consecutive series of these patients, and serial changes in conduit geometry were accessed in 16 patients who underwent catheter examinations twice at 1.1 +/- 0.4 and 4.5 +/- 1.4 years postoperatively.
  
  
  RESULTS
  There was one early and one late death. Except for a patient with apicocaval juxtaposition in whom a conduit occlusion developed caused by compression between the vertebral bodies and the ventricle, there were no important complications. Angiographically, conduit volume, estimated by using the MULTI-SLICE method, increased significantly (3490 +/- 2166 to 5426 +/- 3081 mm3, P < .001), whereas the volume per body weight remained unchanged. Conduit diameter increased significantly at both the inferior vena caval end (16.8 +/- 4.8 to 19.8 +/- 4.8 mm, P < .001) and the pulmonary artery end (11.9 +/- 3.8 to 14.2 +/- 4.2 mm, P < .001), whereas the diameter indexed to the normal right pulmonary artery remained unchanged. The cross-sectional area of the conduit increased in parallel with that of the normal right pulmonary artery. The ratio of the widest to the narrowest diameter of the conduit exhibited no significant change.
  
  
  CONCLUSIONS
  Midterm results of the Fontan operation with pedicled autologous pericardial roll were favorable. Proportional increase of conduit size was demonstrated, with its shape preserved. This suggested a potential of the conduit to grow and that growth correlated with somatic development.
authors.affiliation: Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
authors.forename: Iki
authors.initials: I
authors.lastname: Adachi
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Yagihara
authors.forename: Koji
authors.initials: K
authors.lastname: Kagisaki
authors.forename: Ikuo
authors.initials: I
authors.lastname: Hagino
authors.forename: Toru
authors.initials: T
authors.lastname: Ishizaka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Koh
authors.forename: Hideki
authors.initials: H
authors.lastname: Uemura
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography; D002648:Child; D002675:Child, Preschool; D018729:Fontan Procedure / Q000379:methods*; D006801:Humans; D007223:Infant; D010496:Pericardium / Q000000981:diagnostic imaging / Q000254:growth & development / Q000637:transplantation*; D012189:Retrospective Studies; D013524:Surgical Flaps