Fontan conversion to one and one half ventricle repair

Area of Science:

• Cardiology
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Modified Fontan connections, especially right atrial to right ventricular, can lead to pulmonary ventricle enlargement over time.
• Patients may present with symptoms like exercise intolerance, arrhythmias, or conduit obstruction.

Purpose of the Study:

• To evaluate the feasibility and outcomes of Fontan conversion to a one and one half ventricle repair in patients with a failing Fontan circulation.

Main Methods:

• A cohort of 10 patients (median age 24 years) with various congenital heart defects underwent Fontan conversion.
• Procedures included tricuspid valve replacement, bidirectional cavopulmonary anastomosis, and arrhythmia surgery.
• Preoperative assessment revealed right atrial enlargement and regurgitation, with elevated right atrial pressure.

Main Results:

• No early mortality was observed; one patient required reoperation for a residual ventricular septal defect.
• Postoperative right atrial pressure decreased significantly (median 10 mm Hg).
• At a median follow-up of 8 years, nine patients were in New York Heart Association class I or II, indicating an excellent quality of life.

Conclusions:

• Fontan conversion to a one and one half ventricle repair is a viable option for selected patients with failing Fontan circulation.
• The procedure is associated with low early mortality and can significantly improve quality of life.
• Routine arrhythmia surgery is recommended during conversion.