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Ann Thorac Surg 2000;69:181-185
© 2000 The Society of Thoracic Surgeons

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Original Articles

Right atrioventricular extracardiac conduit as a Fontan modification: late results

^a Grown-up Congenital Heart Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, England, United Kingdom

Address reprint requests to Dr Dore, Institut de Cardiologie de Montréal, 5000 Belanger est, Montreal QC, H1T 1C8, Canada;
e-mail: annie.dore{at}sympatico.ca

Background. The right ventricle, when incorporated in the Fontan circulation, might enlarge and function as a pump to the pulmonary circulation. Experience has shown that over the long-term, this operation can be associated with major difficulties.

Methods. The late results, (13 ± 6 years) after right atrioventricular connection as a Fontan modification, were reviewed in 14 patients with tricuspid atresia (11), ventricular septal-defect with small right ventricle (2), and double inlet left ventricle (1) to assess the long-term survival, the right ventricular size, and the need and timing of reoperations. Operations used a valved conduit (7), a valveless Dacron (E.L. Bard, Haverhill, PA) tube (5) and a direct right atrium-right ventricle anastomosis (2).

Results. Death occurred in 5 by 8 ± 5 years. Conduit obstruction occurred in 10 by 9 ± 3 years equally in patients with valved (6 of 7) compared to patients with valveless conduits (4 of 5) and irrespective of right ventricular size (3 of 4 with enlarged right ventricle versus 4 of 6 with small ventricle). Patients with direct atrioventricular anastomosis had no obstruction. Reoperation was performed in 9 but failed to relieve the obstruction in 4 because of external compression (4) with or without thrombosis (1).

Conclusions. Right atrioventricular connection as a Fontan modification can provide good early palliation, but is a poor long-term solution, as it is associated with a high incidence and difficulties in relieving the obstruction.

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