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Conversion of the failed Fontan circulation

Published online by Cambridge University Press:  10 January 2006

Carl L. Backer ,
Barbara J. Deal ,
Constantine Mavroudis ,
Wayne H. Franklin  and
Robert D. Stewart
Carl L. Backer
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Barbara J. Deal
Affiliation:
Division of Cardiology, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Constantine Mavroudis
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Wayne H. Franklin
Affiliation:
Division of Cardiology, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Robert D. Stewart
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Extract

Many patients with a functional univentricular heart were treated in the 1970s and 1980s, using an atriopulmonary connection to create the Fontan circulation.1–3 Although this procedure, in many patients, was initially successful, and provided arterial saturations of oxygen close to normal, as these patients were followed over the years, in some cases they developed significant complications. One complication of the atriopulmonary connection is progressive right atrial dilation, which leads to atrial arrhythmias, such as atrial flutter or fibrillation.4,5 The combination of these two problems leads to low cardiac output, diminished quality of life, and poor categorization within the classification of the New York Heart Association. This, and other issues, has led most centres to abandon the atriopulmonary connection as a means of creating the Fontan circulation in favour of the lateral tunnel with cavopulmonary connections,6 or the extracardiac conduit.7

Keywords

Functionally univentricular heartarrhythmiascardiac failuredouble inlet ventricleatrioventricular valvar atresia

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