HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kiaffas, M. G. Articles by Green, D. W. Search for Related Content PubMed PubMed Citation Articles by Kiaffas, M. G. Articles by Green, D. W.

Ann Thorac Surg 1999;67:1746-1753
© 1999 The Society of Thoracic Surgeons

---

Original Articles

The modified Fontan procedure: morphometry and surgical implications

^a Departments of Pathology and Cardiology, Children’s Hospital, Boston, Massachusetts, USA
^b Departments of Pathology and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA

Accepted for publication December 16, 1998.

Address reprint requests to Dr Van Praagh, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115
e-mail: gaskill{at}a1.tch.harvard.edu

Background. The modified Fontan procedure for patients with only one well-formed ventricle is now widely regarded as palliative, not curative.

Methods. To improve the surgical management and postoperative follow-up of such patients, a morphometric study of 33 postmortem cases was done.

Results. The three main causes of death were congestive heart failure (82%), arrhythmias (12%), and central nervous system dysfunction (6%). The cross-sectional area of the Fontan anastomosis (FA) relative to the systemic venous area (SVA) and relative to the body surface area (BSA) revealed that the Fontan pathway was often obstructive. The mean FA/SVA index was 73% less than normal: 0.54 ± 0.22, range 0.13 to 0.98. The mean FA/BSA index was 70% less than normal: 143.52 ± 50.01 mm²/M², range 55.09 to 261.67 mm²/M².

Conclusions. The main surgical challenge is to minimize or eliminate prepulmonary stenosis. Although significant postoperative obstruction was often not evident hemodynamically because of small or absent gradients, the presence of important obstruction of the Fontan pathway was clearly revealed by morphometry.

This article has been cited by other articles:

				V. Sojak, U. Mazic, M. Cesen, J. Schrader, and N. Danojevic Cardiac resynchronization therapy for the failing fontan patient. Ann. Thorac. Surg., June 1, 2008; 85(6): 2136 - 2138. [Abstract] [Full Text] [PDF]

				E. A. Bacha, F. J. Zimmerman, V. Mor-Avi, L. Weinert, J. P. Starr, L. Sugeng, and R. M. Lang Ventricular Resynchronization by Multisite Pacing Improves Myocardial Performance in the Postoperative Single-Ventricle Patient Ann. Thorac. Surg., November 1, 2004; 78(5): 1678 - 1683. [Abstract] [Full Text] [PDF]

				R. Kaulitz, G. Ziemer, T. Paul, M. Peuster, H. Bertram, and G. Hausdorf Fontan-type procedures: residual lesions and late interventions Ann. Thorac. Surg., September 1, 2002; 74(3): 778 - 785. [Abstract] [Full Text] [PDF]

				V. Alexi-Meskishvili, S. Ovroutski, I. Dahnert, P. E. Lange, and R. Hetzer Early experience with extracardiac Fontan operation Ann. Thorac. Surg., January 1, 2001; 71(1): 71 - 76. [Abstract] [Full Text] [PDF]

				V. Alexi-Meskishvili, S. Ovroutski, P. Ewert, I. Dahnert, F. Berger, P. E. Lange, and R. Hetzer Optimal conduit size for extracardiac Fontan operation Eur. J. Cardiothorac. Surg., December 1, 2000; 18(6): 690 - 695. [Abstract] [Full Text] [PDF]