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The extracardiac Fontan procedure.

Charles B. Huddleston1

  • 1Department of Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO.

Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
|August 4, 2001
PubMed
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The extracardiac Fontan procedure offers improved outcomes for single ventricle heart defects by rerouting blood flow without aortic clamping. This modification shows promise in reducing complications like atrial flutter, though long-term pathway growth and obstruction risks require further study.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • The Fontan procedure is a palliative surgery for complex single ventricle congenital heart disease.
  • Previous modifications aimed to improve short-term and long-term outcomes.
  • Atrial flutter is a common complication in traditional Fontan procedures.

Purpose of the Study:

  • To evaluate the extracardiac modification of the Fontan procedure.
  • To assess its safety and efficacy in complex single ventricle congenital cardiac disease.
  • To compare its outcomes with other Fontan modifications.

Main Methods:

  • Detachment of the inferior vena cava from the heart.
  • Connection of the inferior vena cava to the pulmonary artery via a conduit.

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  • Utilizing fluid dynamic advantages of cavopulmonary connections.

    • Main Results:

    • Reduced incidence of atrial flutter compared to other modifications.
    • Avoidance of aortic cross-clamping during the procedure.
    • Prosthetic material is not exposed to the systemic circulation.

    Conclusions:

    • The extracardiac Fontan modification demonstrates favorable intermediate-term results.
    • Potential advantages include reduced atrial flutter.
    • Long-term concerns include pathway growth, obstruction risk, and late arrhythmias.