Conversion of atriopulmonary Fontan to extracardiac total cavopulmonary connection improves cardiopulmonary function.
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.
Giardini
Alessandro
A
Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. alessandro5574@iol.it
Pace Napoleone
Carlo
C
Specchia
Salvatore
S
Donti
Andrea
A
Formigari
Roberto
R
Oppido
Guido
G
Gargiulo
Gaetano
G
Picchio
Fernando M
FM
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