Cardiovascular status after repair by Fontan procedure

Area of Science:

• Cardiology
• Pediatric Surgery
• Congenital Heart Disease

Background:

• The Fontan procedure significantly improves symptoms in patients with single-ventricle physiology.
• Long-term outcomes and potential complications after the Fontan operation require ongoing investigation.

Purpose of the Study:

• To present the clinical course and hemodynamic findings of long-term Fontan survivors.
• To identify and discuss late complications following the Fontan procedure.

Main Methods:

• Retrospective review of 5 long-term Fontan survivors from the institution.
• Literature review of reported long-term outcomes and complications.

Main Results:

• Three patients required reoperation for pulmonary stenosis, complete heart block, and conduit valve stenosis.
• Ascites and pleural effusions due to high venous pressures were common but usually temporary.
• Late obstruction of right atrial emptying and tolerance of arrhythmias were observed.

Conclusions:

• The Fontan procedure is effective with acceptable operative risk but necessitates vigilant long-term patient monitoring.
• Concerns exist regarding the durability of cloth conduits and porcine valves.
• Normal sinus rhythm may not be essential for adequate pulmonary perfusion in all Fontan survivors.