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Ann Thorac Surg 1989;47:761-764
© 1989 The Society of Thoracic Surgeons

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Articles

Direct tricuspid closure versus atrial partitioning in Fontan operation for complex lesions

^a Divisions of Cardiovascular-Thoracic Surgery and Cardiology, The Children's Memorial Hospital, Chicago, Illinois, USA
^b Departments of Surgery and Pediatrics, Northwestern University Medical School, Chicago, Illinois, USA

Accepted for publication December 29, 1988.

^_* Address reprint requests to Dr DeLeon, Division of Cardiovascular-Thoracic Surgery, The Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614.

Thirty-three patients with complex lesions undergoing the Fontan operation needed either direct tricuspid closure (group 1, 14 patients) or atrial partitioning (group 2, 19 patients). In group 1, the tricuspid patch was sutured to the annulus leaving the coronary sinus draining to the systemic venous atrium. In group 2, atrial partitioning was accomplished with either a Dacron or a polytetrafluoroethylene patch, leaving the coronary sinus draining to the pulmonary venous atrium. Intraoperative distention of the left side was used to check for residual defects. In group 1, complete heart block developed in 5 patients (36%) and patch disruption, in 4 patients (29%). There were 3 late deaths (21%), which were due to sudden death, sepsis caused by Candida, and liver failure. In group 2, no patient had heart block, and patch disruption developed in 1 patient (5%). There was 1 early death (5%) and 2 late deaths (11%), which were due to sepsis caused by Candida and renal failure. Our experience suggests that atrial partitioning is a better approach than direct tricuspid patch closure in patients with complex lesions undergoing the Fontan operation.

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