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Ann Thorac Surg 1995;60:S568-S571
© 1995 The Society of Thoracic Surgeons

Articles

Conversion of the hemi-Fontan procedure to fenestrated total extracardiac cavopulmonary bypass

MD Hani A. Hennein*, MD Hidayet T. Kililtan, MD Robert M. Sade

Section of Pediatric Cardiac Surgery, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York, USA

* Address reprint requests to Dr Hennein, Section of Pediatric Cardiothoracic Surgery, Schneider's Children's Hospital, Long Island Jewish Medical Center, 269-01 76th Ave, New Hyde Park, NY 11040.
*


   Abstract
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 Abstract
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Background: Arrhythmias occur frequently after Fontan operations, and are related in part to high atrial pressure, wall distention, and scarring caused by extensive suture lines. These arrhythmic factors may be avoided by an extracardiac total cavopulmonary anastomosis. We have embarked on a program of conversion of the hemi-Fontan operation to a fenestrated extracardiac Fontan procedure with a relatively simple operation.

Methods: In a 4-month period ending in December 1994, 4 consecutive patients underwent this procedure. The inferior vena cava was divided and the cardiac end was oversewn. A large (20 to 25 mm) ascending aortic homograft, from which the inlet portion and valve had previously been excised, was interposed between the divided distal end of the inferior vena cava and the hood of the superior cavopulmonary anastomosis. A 4-mm fenestration with a pursestring snare mechanism was placed within the cavoatrial patch that had been implanted at the time of the hemi-Fontan procedure.

Results: There were no deaths, and the average length of stay was 12 ± 4 days (range, 8 to 18 days). In early follow-up, there have been no atrial arrhythmias, and three of the four fenestrations have been documented to be patent.

Conclusions: An extracardiac fenestrated Fontan procedure can safely and successfully be performed after a hemi-Fontan operation, and may have both hemodynamic and arrhythmic benefits.


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 Abstract
 References
 

  1. Kurer CC, Tanner CS, Norwood WI, Vetter VL. Perioperative arrhythmias after Fontan repair Circulation 1990;82(Suppl 4):190-194.
  2. Peters NS, Somerville J. Arrhythmias after the Fontan pro-cedure Br Heart J 1992;68:199-204.[Abstract/Free Full Text]
  3. Marcelletti C, Corno A, Giannico S, Marino B. Inferior vena cava-pulmonary artery extracardiac conduit. A new form of right heart bypass J Thorac Cardiovasc Surg 1990;100:228-232.[Abstract]
  4. Giannico S, Corno A, Marino B, et al. Total extracardiac right heart bypass Circulation 1992;86(Suppl 2):110-117.
  5. Douville EC, Sade RM, Fyfe DA. Hemi-Fontan operation in surgery for single ventricle: a preliminary report Ann Thorac Surg 1991;51:893-900.[Abstract/Free Full Text]
  6. Norwood WI, Jacobs ML. Fontan's procedure in two stages Am J Surg 1993;166:548-551.[Medline]
  7. Jonas RA, Castañeda AR. Modified Fontan procedure: atrial baffle and systemic venous to pulmonary artery anastomotic techniques J Cardiac Surg 1988;3:91-96.[Medline]
  8. Lamberti JJ, Mainwaring RD, Billman GF, et al. The cryopre-served homograft valve in the pulmonary position: mid-term results and technical considerations J Cardiac Surg 1991;6:627-632.[Medline]
  9. Corno A, Giamberti A, Giannico S, et al. Long-term results after extracardiac valved conduits implanted for complex congenital heart disease J Cardiac Surg 1988;3:495-500.[Medline]
  10. Deanfield J, Camm J, Macartney F, et al. Arrhythmia late mortality after Mustard and Senning operation for transpo-sition of the great arteries. An eight-year prospective study J Thorac Cardiovasc Surg 1988;96:569-576.[Abstract]



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This Article
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