Document Detail

Modified Fontan operation in the presence of anomalies of systemic and pulmonary venous connection.
MedLine Citation:
PMID:  7693364     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The purpose of this report is to outline technical maneuvers dictated by anomalies of systemic and/or pulmonary venous connection in the performance of the Fontan procedure. METHODS AND RESULTS: Between 1975 and 1990, 104 patients (60 male, 44 female) with anomalies of systemic and/or pulmonary venous connection underwent a modified Fontan procedure at the Mayo Clinic. Mean age was 9.7 +/- 5.7 years. Isolated anomalies of the systemic venous connection were identified in 46 patients, isolated anomalous pulmonary venous connections in 4, and a combination of the two in 54. Previous palliative operations had been performed in 93 patients. Surgical repair was accomplished by atrial septation or placement of an intra-atrial conduit combined with cavopulmonary anastomosis if required. Survival by Kaplan-Meier, including operative mortality, was 55.7% at 10.3 years, not significantly different from the overall survival of the Fontan population. By the proportional hazards general linear model procedure, insufficiency of the systemic atrioventricular valve, preoperative mean pulmonary pressure greater than 15 mm Hg, and pulmonary artery resistance index greater than 4 U.m2 were associated with higher mortality. Five patients required reoperation for pulmonary venous obstruction (1 patient), revision of the atrial baffle (1 patient), revision of the intra-atrial conduit (2 patients), and replacement of the systemic atrioventricular valve (1 patient). CONCLUSIONS: We conclude that the modified Fontan operation can be successfully performed in this subset of patients, with long-term results comparable to those obtained in patients with normal systemic and pulmonary venous connection.
G Michielon; F Gharagozloo; P R Julsrud; G K Danielson; F J Puga
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  88     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1993 Nov 
Date Detail:
Created Date:  1993-11-29     Completed Date:  1993-11-29     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  II141-8     Citation Subset:  AIM; IM    
Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
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MeSH Terms
Cardiac Surgical Procedures / methods,  mortality
Follow-Up Studies
Heart Defects, Congenital / mortality,  surgery*
Hospital Mortality
Palliative Care
Proportional Hazards Models
Pulmonary Veins / abnormalities*
Survival Analysis
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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