title: Conversion of atriopulmonary Fontan to extracardiac total cavopulmonary connection improves cardiopulmonary function.
abstract: BACKGROUND
  Experimental studies showed that extracardiac total cavopulmonary connection provides superior hemodynamics than atriopulmonary Fontan.
  
  
  METHODS
  We prospectively assessed the impact of conversion of atriopulmonary Fontan to extracardiac total cavopulmonary connection on exercise capacity and cardiac function in 6 consecutive patients.
  
  
  RESULTS
  Six months after conversion to extracardiac total cavopulmonary connection, we observed an increase in peak oxygen uptake in all patients (p=0.01;+17%). This improvement was associated to an increase of peak O(2) pulse (p=0.01;+16%), but no change in peak heart rate, arterial oxygen saturation at peak exercise, and pulmonary function. Ventricular ejection fraction did not change significantly after surgery. Conversion was associated with an improvement in heart failure symptoms as assessed by the New York Heart Association classification. Patients who had undergone additional anti-arrhythmia surgery for atrial fibrillation had no recurrence of arrhythmia at follow-up.
  
  
  CONCLUSIONS
  Data indicate that conversion to extracardiac total cavopulmonary connection is associated with an improvement of cardiopulmonary function and heart failure symptoms. Improved exercise capacity is due to an increase in O(2) pulse and may reflect an improved cardiac stroke volume after the operation.
authors.affiliation: Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. alessandro5574@iol.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giardini
authors.forename: Carlo
authors.initials: C
authors.lastname: Pace Napoleone
authors.forename: Salvatore
authors.initials: S
authors.lastname: Specchia
authors.forename: Andrea
authors.initials: A
authors.lastname: Donti
authors.forename: Roberto
authors.initials: R
authors.lastname: Formigari
authors.forename: Guido
authors.initials: G
authors.lastname: Oppido
authors.forename: Gaetano
authors.initials: G
authors.lastname: Gargiulo
authors.forename: Fernando M
authors.initials: FM
authors.lastname: Picchio
mesh_terms: D000293:Adolescent; D000328:Adult; D015444:Exercise; D018729:Fontan Procedure; D006321:Heart / Q000502:physiology*; D018610:Heart Bypass, Right / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D011446:Prospective Studies