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Modified Fontan procedure in patients less than 4 years of age

J M Pearl1, H Laks, D C Drinkwater

  • 1Department of Surgery, University of California, Los Angeles Medical School.

Circulation
|November 1, 1992
PubMed

Insights

The modified Fontan procedure is safe and effective for children under 4 years old, offering improved clinical outcomes. Early intervention in select patients can protect pulmonary vascular beds and preserve ventricular function.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Surgery
  • Pediatric Cardiac Critical Care

Background:

  • The modified Fontan procedure in young children (< 4 years) initially had variable success and high mortality.
  • Recent advancements have improved outcomes for the modified Fontan procedure in younger pediatric populations.
  • Early Fontan palliation offers benefits like pulmonary vascular bed protection and preserved ventricular function.

Purpose of the Study:

  • To evaluate the safety and efficacy of the modified Fontan procedure in patients younger than 4 years.
  • To compare early and late outcomes in this pediatric cohort.

Main Methods:

  • A retrospective review of 90 patients under 4 years old who underwent a modified Fontan procedure between 1982 and May 1991.
  • Patients' diagnoses included tricuspid atresia, single ventricle, pulmonary atresia, and hypoplastic left heart syndrome.
  • An adjustable atrioseptostomy (ASD) was utilized in 21 cases.

Main Results:

  • The early mortality rate was 8.9% (8/90), comparable to the overall Fontan early mortality of 7.4%.
  • For patients under 2 years old (n=30), the early mortality was 6.7% (2/30).
  • Mean follow-up of 38 months revealed three late deaths (3.7%) and one cardiac transplant.

Conclusions:

  • The modified Fontan procedure can be safely performed in patients under 4 years old, yielding good clinical results.
  • Early Fontan palliation is recommended for infants over 6 months with progressive cyanosis and favorable hemodynamics.
Abstract

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