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The modified Fontan operation in hearts associated with atrioventricular valvar atresia or common atrioventricular valve—neoseptation of the atriums using a right atrial flap

Published online by Cambridge University Press:  19 August 2008

Tayyar Sarioglu ,
Tufan Paker ,
Halil Türkoglu ,
Atif Akçevin ,
Ayse Sarioglu ,
Yusuf Yalçinbas ,
Belhan Akpinar  and
Aydin Aytaç
Tayyar Sarioglu
Affiliation:
Department of Cardiovascular Surgery, University of Istanbul, Istanbul
Tufan Paker
Affiliation:
Department of Cardiovascular Surgery, University of Istanbul, Istanbul
Halil Türkoglu
Affiliation:
Department of Cardiovascular Surgery, University of Istanbul, Istanbul
Atif Akçevin
Affiliation:
Department of Cardiovascular Surgery, University of Istanbul, Istanbul
Ayse Sarioglu
Affiliation:
Department of Cardiovascular Surgery, University of Istanbul, Istanbul
Yusuf Yalçinbas
Affiliation:
Department of Cardiovascular Surgery, University of Istanbul, Istanbul
Belhan Akpinar
Affiliation:
Department of Cardiovascular Surgery, University of Istanbul, Istanbul
Aydin Aytaç*
Affiliation:
Department of Cardiovascular Surgery, University of Istanbul, Istanbul
*
Dr. Aydin aytaçProfessor of Cardiovascular Surgery, Department of Cardiovascular Surgery, University of Istanbul Institute of Cardiology, 34304 Haseki-Istanbul, Turkey. Tel. 90-212-589-6205; Fax.90-212-529-4262.
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Summary

Summary Between June 1988 and December 1992, six patients with dominant left and rudimentary right ventricles underwent orthoterminal correction with a modified Fontan operation in which the atriums were neoseptated using a flap constructed from the right atrial wali. Four patients had anomalous systemic venous connections. The operations were performed under direct caval cannulation, standard cardiopulmonary bypass, moderate hypothermia and cardioplegic arrest. After opening the right atrium with a longitudinal incision, the atrial septum was completely resected and the coronary sinus was cut back. The upper wall of the right atrial incision was brought down in such a way that the pulmonary venous atrium was drained into the dominant ventricle via the right-sided or common atrioventricular valve. This was followed by direct connection of the right atrium with its anterior wall reconstructed with pericardium to the pulmonary arteries. In one patient, a left superior caval vein draining to the left atrium was divided and anastomosed to left pulmonary artery. One patient died on the 12th postoperative day with pulmonary infection and sepsis, though he had no hemodynamic problem, and another died on the sixth day due to high pulmonary vascular resistance. The remaining four patients are progressing well at a mean of 23.4 months postoperatively with functional capacity of NYHA I-IT and sinus rhythm. Echocardiographic and angiocardiographic examinations during follow-up showed unobstructed pulmonary and systemic venous pathways in all. This modification of the Fontan operation seems a good alternative technique which creates a contractile left atrium with large enough dimensions and an unobstructed pathway for pulmonary venous flow.

Keywords

Left sided atrioventricular valvar atresiauniventricular atrioventricular connectionmodified Fontan operationatrial neoseptation
Type
Original Articles
Information
Cardiology in the Young , Volume 4 , Issue 4 , October 1994 , pp. 353 - 357
Copyright
Copyright © Cambridge University Press 1994

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References

1.Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.CrossRefGoogle ScholarPubMed
2.Kreutzer, G, Galindez, E, Bono, H, De Palma, C, Laura, JP. An operation for the correction of tricuspid atresia. J Thorac Cardiovasc Surg 1973; 66: 105–111.CrossRefGoogle ScholarPubMed
3.Molina, EJ, Wand, Y, Lucas, R, Moller, J. The technique of the Fontan procedure with posterior right atrium-pulmonary artery connection. Ann Thorac Surg 1985; 39: 371–375.CrossRefGoogle ScholarPubMed
4.Sarioglu, T, Bilgiç, A, Ikizler, C, Yurdakul, Y, Paker, T, Akçevin, A, Özer, S, Aytaç, A. Fontan procedure for correction of complex congenital anomalies. Turkish J Pediat 1985; 27: 135–146.Google Scholar
5.Matsuda, H, Kawashima, Y, Kishimoto, H, Hirose, H, Nakano, S, Kato, H, Kazuhiro, T, Kyoutchi, N, Tetsuya, S, Minoru, O. Problems in the modified Fontan operation for univentricular heart of the right ventricular type. Circulation 1987; 76 (Suppl III): III 45–III 52.Google ScholarPubMed
6.Vargas, FJ, Mayer, JE, Jonas, RA, Castañfleda, AR. Anomalous systemic and pulmonary venous connections in conjunction with atriopulmonary anastomosis (Fontan-Kreutzer). J Thorac Cardiovasc Surg 1987; 93: 523–532.CrossRefGoogle ScholarPubMed
7.Puga, FJ, Chiavarelli, M, Hagler, DJ. Modifications of the Fontan operation applicable to patients with left atrioven tricular valve atresia or single atrioventricular valve. Circulation 1987; 76: 53–60.Google ScholarPubMed
8.Thiene, G, Dallento, L, Frescura, C, Tommasi, MD, McCartney, JF, Anderson, RH. Atresia of left atrioventricular orifice. Anatomical investigation of 62 cases. Br Heart J 1981; 45: 393–401.CrossRefGoogle ScholarPubMed
9.Gittenberg-de Groot, AC, Wenink, ACG. Mitral atresia, morphological details. Br Heart J 1984; 51: 253–257.Google Scholar
10.Laks, H, Milliken, JC, Perlof, JK, Hellenbrand, WE, George, BL, Chin, A. Experience with the Fontan procedure. J Thorac Cardiovasc Surg 1984; 88: 939–951..CrossRefGoogle ScholarPubMed
11.Gale, AW, Danielson, GJ, McGoon, DC, Mair, DD. Modified Fontan operation for univentricular heart and complicated lesions. J Thorac Cardiovasc Surg 1979; 78: 831–838.CrossRefGoogle Scholar
12.Di, Carlo, Marceletti, C, Nijweld, A, Lubbers, U, Becker, AE. The Fontan procedure in the absence of the interatrial septum:Failure of its principle? J Thorac Cardiovasc Surg 1983; 85: 923–927.Google Scholar
13.Jonas, RD, Castañeda, AR. Modified Fontan procedures, atrial baffle and systemic venous to pulmonary artery anastomotic techniques. J Card Surg 1988; 3: 91–96.CrossRefGoogle ScholarPubMed
14.Mickell, JJ, Mathews, RA, Park, SC, Lenox, CC, Fricker, FJ, Neches, WH, Zuberbuhler, JR. Left atrioventricular valve atresia: clinical management. Circulation 1980; 61: 123–127.CrossRefGoogle ScholarPubMed
15.Keith, JD. Congenital mitral atresia. Keith, JD, Rowe, RD, Vlad, P, (eds). Heart Disease in Infancy and Childhood, 3rd edition. Macmillan, New York, 1978, p. 552.Google Scholar
16.Hait, G, Lev, M, Rudolf, AM. Size of the interatrial communication in mitral atresia and stenosis. Anatomical, physiological and surgical considerations. Circulation 1967; 36(Suppl II): II 130–II 138.Google Scholar
17.Anderson, RH, Ho, SY, Rigby, ML. The anatomic spectrum of hearts with univentricular atrioventricular connection. Moulton, AL, (ed). Congenital Heart Surgery. Current Techniques and Controversies. Appleton Davies, Pasadena, 1984, p. 258.Google Scholar
18.Fantidis, P, Salvador, C, Ruiz, F, Amat, CG, Martínez, P, Ruiz, C, Díaz, FA. A new surgical technique for orthoterminal correction: Experimental Development. Ann Thorac Surg 1985; 39: 450–455.CrossRefGoogle ScholarPubMed
19.Pearl, JM, Laks, H, Stein, DG, Drinkwater, DC, George, BL, Williams, RG. Total cavopulmonaly anastomosis versus conventional modified Fontan procedure. Ann Thorac Surg 1991; 52: 189–196.CrossRefGoogle ScholarPubMed
20.De Leval, MR, Kilner, P, Gewilling, M, Bull, C. Total cavopulmonary connection: A logical alternative to atriopulmonary connection for complex Fontan operations. J Thorac Cardiovasc Surg 1988; 96: 682–695.CrossRefGoogle ScholarPubMed