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Anton E. Becker
Cosimo Squitieri
Carlo Marcelletti
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Ann Thorac Surg 1985;39:283-285
© 1985 The Society of Thoracic Surgeons

Articles

Ventricular Exclusion during Fontan Operation: An Evolving Technique

Roberto di Donato, M.D., Anton E. Becker, M.D., Aagje Nijveld, M.D., Jan Lam, M.D., Anton Bulterijs, M.D., Cosimo Squitieri, M.D., Carlo Marcelletti, M.D.*

From the Departments of Pathology, Pediatric Cardiac Surgery, and Pediatric Cardiology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands, and the Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, Rome, Italy

Accepted for publication May 16, 1984.

* Address reprint requests to Dr. Marcelletti, Department of Pediatric Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, Piazza San Onofrio 4, 00165 Rome, Italy

The modified Fontan operation, which consists of ventricular exclusion by obliteration of the right atrioventricular ostium, requires a technique that provides firm and permanent occlusion while preserving the atrioventricular node and bundle. Ten patients underwent such an operation. In 5 of them, closure of the right atrioventricular ostium was achieved by suturing a patch into the valve leaflets; in the other 5, the ventricle was excluded by a patch sutured into the right atrial wall above the annulus fibrosus. None of the patients who underwent this procedure experienced heart block postoperatively. However, three instances of late patch dehiscence occurred, each in the group of patients in whom the patch had been attached to the valve leaflets. We conclude that both patching techniques are safe as far as the atrioventricular node and bundle are concerned but that permanent occlusion is better obtained by implanting the patch into the atrial wall. Therefore, we prefer to use this technique.




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