title: Fontan completions over 10 years after Glenn procedures.
abstract: OBJECTIVE
  Despite the broadened indications for Fontan procedure, there are patients who could not proceed to Fontan procedure because of the strict Fontan criteria during the early period. Some patients suffer from post-Glenn complications such as hypoxia, arrhythmia, or fatigue with exertion long after the Glenn procedure. We explored the possibility of Fontan completion for those patients.
  
  
  METHODS
  Between 2004 and 2010, five consecutive patients aged between 13 and 31 years (median 21) underwent Fontan completion. These patients had been followed up for more than 10 years (10 to 13, median 11) after Glenn procedure as non-Fontan candidates. We summarise these patients retrospectively in terms of their pre-operative physiological condition, surgical strategy, and problems that these patients hold.
  
  
  RESULTS
  Pre-operative catheterisation showed pulmonary vascular resistance ranging from 0.9 to 3.7 (median 2.2), pulmonary to systemic flow ratio of 0.3 to 1.6 (median 0.9), and two patients had significant aortopulmonary collaterals. Extracardiac total cavopulmonary connections were performed in three patients, lateral tunnel total cavopulmonary connection in one patient, and intracardiac total cavopulmonary connection in one patient, without a surgical fenestration. Concomitant surgeries were required including valve surgeries--atrioventricular valve plasty in three patients and tricuspid valve replacement in one patient; systemic outflow tract obstruction release--Damus-Kaye-Stansel procedure in two patients and subaortic stenosis resection in one patient; and anti-arrhythmic therapies--maze procedure in two patients, cryoablation in two patients, and pacemaker implantation in two patients. All patients are now in New York Heart Association category I.
  
  
  CONCLUSIONS
  Patients often suffer from post-Glenn complications. Of those, if they are re-examined carefully, some may have a chance to undergo Fontan completion and benefit from it. Multiple lesions such as atrioventricular valve regurgitation, systemic outflow obstruction, or arrhythmia should be surgically repaired concomitantly.
authors.affiliation: 1 Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sughimoto
authors.affiliation: 2 Department of Cardiac Surgery, Chiba Cardiovascular Center, Ichihara, Japan.
authors.forename: Kozo
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: 4 Department of Cardiology, St. Luke International Hospital, Tokyo, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Niwa
authors.affiliation: 5 Department of Pediatrics, Chiba Cardiovascular Center, Ichihara, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Kawasoe
authors.affiliation: 3 Adult Congenital Heart Disease Program, Chiba Cardiovascular Center, Ichihara, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tateno
authors.affiliation: 4 Department of Cardiology, St. Luke International Hospital, Tokyo, Japan.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Shirai
authors.affiliation: 2 Department of Cardiac Surgery, Chiba Cardiovascular Center, Ichihara, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kabasawa
authors.affiliation: 2 Department of Cardiac Surgery, Chiba Cardiovascular Center, Ichihara, Japan.
authors.forename: Masanao
authors.initials: M
authors.lastname: Ohba
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003097:Collateral Circulation / Q000502:physiology; D004310:Double Outlet Right Ventricle / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D018579:Patient Selection; D011666:Pulmonary Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012587:Scimitar Syndrome / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014655:Vascular Resistance / Q000502:physiology; D055815:Young Adult