Neointimal obstruction of Carpentier-Edwards valved conduit in two patients with modified Fontan procedure

In 2 patients (single ventricle and dextrotransposition of the great arteries with hypoplastic right ventricle) who underwent a modified Fontan procedure, significant disruption of the tricuspid patch developed. The valved conduits remained patent until reoperation at two and six months, respectively. At the time of reclosure of the tricuspid patch, unavoidable manipulation of the conduits from dissection of adhesions led to detachment and collapse of the neointima, thereby producing complete obstruction of the conduit. The problem was detected immediately in the first patient and prompted clearance of the conduit of the collapsed neointima. In the second patient, the diagnosis was made six months later and conduit replacement was required. Both patients did well following reoperation. We suggest that in patients with woven valved conduits inserted for a Fontan procedure who require reoperation and extensive manipulation of the conduit, removal of the neointima or conduit replacement should be considered.