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Converting Fontan-Björk to 1.5- or 2-Ventricle Circulation
Kali A Hopkins1, John W Brown2, Robert K Darragh3
1Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
The Annals of Thoracic Surgery
|October 14, 2018
Summary
Surgical conversion of the Fontan with "Björk" modification to a 2-ventricle or 1.5-ventricle circulation may improve patient hemodynamics and clinical status. This approach can potentially delay the need for heart transplantation in patients with tricuspid atresia and ventricular septal defect.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiac Physiology
Background:
- Tricuspid atresia with ventricular septal defect (VSD) historically led to Fontan procedures with "Björk" modification.
- This surgical approach, though rarely performed now, is associated with significant long-term complications and reintervention needs.
Purpose of the Study:
- To investigate the hypothesis that surgical conversion to a 2-ventricle or 1.5-ventricle circulation can improve outcomes.
- To assess the impact of this conversion on hemodynamics and clinical status in affected patients.
Main Methods:
- Review of surgical outcomes in patients with tricuspid atresia and VSD previously treated with a "Björk" modified Fontan.
- Presentation of two successful case studies demonstrating surgical conversion to a 2-ventricle or 1.5-ventricle physiology.
Main Results:
- Surgical conversion was successfully performed in two patients.
- The conversion aimed to improve hemodynamics and clinical status, potentially extending the time to heart transplantation.
Conclusions:
- Surgical conversion to a 2-ventricle or 1.5-ventricle circulation is a viable strategy for managing complications of the "Björk" modified Fontan.
- This approach may offer improved long-term outcomes and delay the need for heart transplantation in select pediatric cardiac patients.
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