Journal of Nippon Medical School: Vol.66 No.1 page.028

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ArticleTitle Modified Fontan operation Considerations for the determination of the appropriate procedure

AuthorList Hitoshi Yamauchi¹⁾ , Yosuke Ishii¹⁾ , Hiroya Omori¹⁾ , Yukiko Takakusaki¹⁾ , Ken-ichi Yamada¹⁾ , Toshimi Yajima¹⁾ , Takashi Nitta¹⁾ , Masami Ochi¹⁾ , Daichi Fukumi²⁾ , Yukiho Kuramochi²⁾ , Takashi Okubo²⁾ Shun-ichi Ogawa²⁾ and Shigeo Tanaka

Affiliation ¹⁾ Department of Surgery II, Division of Cardiovascular Surgery and ²⁾ Department of Pediatrics, Nippon Medical School

Language EN

Volume 66

Issue 1

Year 1999

Page 28-32

Received September 7, 1998

Accepted December 4, 1998

Keywords modified Fontan operation, extracardiac conduit, autogenous atrial tunnel

Abstract Abstract Background; Although the surgical results of the modified Fontan operation continues to improve, there are various advantages and disadvantages in terms of the post operative condition associated with the Fontan modifications. Late morbidity and mortality are mainly due to arrhythmias, thromboembolic complications, systemic venous hypertension and infective endocarditis. We reported our experience of the modified Fontan operation to determine an appropriate procedure for each patient. Methods and Results; Seven patients (ranging from the age 1~14 years) underwent a modified Fontan operation including a lateral tunnel (n=1), extracardiac conduit (n=2) and autogenous atrial tunnel (n=4). There was one hospital death due to sepsis in which the patient underwent lateral tunnel procedure. The mean follow up of another six patients was 20 months (ranging from 1~39 months) and all patients were classified as NYHA class I, and remained in normal sinus rhythm without any thromboembolic complications. Conclusions; When using the autogenous atrial tunnel, there are potential advantages; it is not associated with thromboembolism or endocarditis and has growth potential. However, in high-risk patients with increased pulmonary vascular resistance, impaired ventricular function and pre-operative atrial arrhythmias, it appears reasonable to use an extracardiac conduit.

Correspondence to Hitoshi Yamauchi, Department of Surgery II, Division of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagei, Bunkyo-ku, Tokyo 113-8603, Japan

ArticleTitle	Modified Fontan operation Considerations for the determination of the appropriate procedure
AuthorList	Hitoshi Yamauchi¹⁾ , Yosuke Ishii¹⁾ , Hiroya Omori¹⁾ , Yukiko Takakusaki¹⁾ , Ken-ichi Yamada¹⁾ , Toshimi Yajima¹⁾ , Takashi Nitta¹⁾ , Masami Ochi¹⁾ , Daichi Fukumi²⁾ , Yukiho Kuramochi²⁾ , Takashi Okubo²⁾ Shun-ichi Ogawa²⁾ and Shigeo Tanaka
Affiliation	¹⁾ Department of Surgery II, Division of Cardiovascular Surgery and ²⁾ Department of Pediatrics, Nippon Medical School
Language	EN
Volume	66
Issue	1
Year	1999
Page	28-32
Received	September 7, 1998
Accepted	December 4, 1998
Keywords	modified Fontan operation, extracardiac conduit, autogenous atrial tunnel
Abstract	Abstract Background; Although the surgical results of the modified Fontan operation continues to improve, there are various advantages and disadvantages in terms of the post operative condition associated with the Fontan modifications. Late morbidity and mortality are mainly due to arrhythmias, thromboembolic complications, systemic venous hypertension and infective endocarditis. We reported our experience of the modified Fontan operation to determine an appropriate procedure for each patient. Methods and Results; Seven patients (ranging from the age 1~14 years) underwent a modified Fontan operation including a lateral tunnel (n=1), extracardiac conduit (n=2) and autogenous atrial tunnel (n=4). There was one hospital death due to sepsis in which the patient underwent lateral tunnel procedure. The mean follow up of another six patients was 20 months (ranging from 1~39 months) and all patients were classified as NYHA class I, and remained in normal sinus rhythm without any thromboembolic complications. Conclusions; When using the autogenous atrial tunnel, there are potential advantages; it is not associated with thromboembolism or endocarditis and has growth potential. However, in high-risk patients with increased pulmonary vascular resistance, impaired ventricular function and pre-operative atrial arrhythmias, it appears reasonable to use an extracardiac conduit.
Correspondence to	Hitoshi Yamauchi, Department of Surgery II, Division of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagei, Bunkyo-ku, Tokyo 113-8603, Japan