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The modified Fontan procedure: morphometry and surgical implications.

M G Kiaffas1, R Van Praagh, C Hanioti

  • 1Department of Pathology, Children's Hospital, and Harvard Medical School, Boston, Massachusetts 02115, USA.

The Annals of Thoracic Surgery
|July 3, 1999
PubMed
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Morphometric analysis of postmortem cases revealed that the Fontan pathway is often obstructive, contributing to mortality in patients with single ventricle physiology. Minimizing obstruction is key to improving outcomes after the modified Fontan procedure.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease Surgery
  • Cardiac Morphology

Background:

  • The modified Fontan procedure is a palliative treatment for single ventricle physiology.
  • Current management focuses on surgical techniques and postoperative care.

Purpose of the Study:

  • To investigate the morphometric characteristics of the Fontan pathway.
  • To identify factors contributing to mortality in post-Fontan patients.

Main Methods:

  • A morphometric study was conducted on 33 postmortem cases.
  • Analysis included the cross-sectional area of the Fontan anastomosis (FA) relative to systemic venous area (SVA) and body surface area (BSA).

Main Results:

  • Congestive heart failure was the primary cause of death (82%).

Related Experiment Videos

  • The Fontan pathway was frequently found to be obstructive, with mean FA/SVA and FA/BSA indices significantly lower than normal.
  • Mean FA/SVA index was 0.54 +/- 0.22 (73% less than normal); mean FA/BSA index was 143.52 +/- 50.01 mm²/M² (70% less than normal).

    • Conclusions:

    • The primary surgical challenge is to reduce or eliminate prepulmonary stenosis.
    • Morphometry revealed significant obstruction in the Fontan pathway, even when not hemodynamically apparent.
    • Addressing Fontan pathway obstruction is crucial for improving surgical outcomes.