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Fontan's operation: an expanded horizon

C Marcelletti, E Mazzera, H Olthof

    The Journal of Thoracic and Cardiovascular Surgery
    |November 1, 1980
    PubMed
    Summary
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    The Fontan operation, a surgical procedure for complex heart defects, demonstrated a high survival rate in 15 patients with various congenital heart conditions. This study supports its use for anatomically uncorrectable heart lesions.

    Area of Science:

    • Cardiology
    • Pediatric Cardiac Surgery

    Background:

    • The Fontan principle, initially for tricuspid atresia, is now applied to a wider range of complex congenital heart diseases.
    • Anatomically uncorrectable congenital heart lesions pose significant therapeutic challenges.

    Purpose of the Study:

    • To evaluate the application and outcomes of the Fontan operation in a diverse group of 15 patients with complex congenital heart malformations.
    • To assess the feasibility and safety of the Fontan principle in treating otherwise inoperable cardiac conditions.

    Main Methods:

    • Surgical application of the Fontan principle in 15 patients with varied congenital heart defects, including tricuspid atresia, double-inlet univentricular heart, and double-outlet right ventricle.
    • Adaptation of the surgical technique to accommodate associated anomalies such as common atrium and anomalous venous connections.

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  • Postoperative survival monitoring and analysis of mortality causes.

    • Main Results:

    • A high survival rate of 13 out of 15 patients (87%) post-Fontan operation.
    • Mortality occurred in one patient with unexpected total anomalous pulmonary venous connections and another with the "asplenic syndrome" due to potential baffle obstruction.
    • Successful application in patients with complex conditions like double-inlet univentricular heart and Ebstein's anomaly.

    Conclusions:

    • The Fontan operation is a viable treatment option for a spectrum of anatomically uncorrectable congenital heart lesions.
    • Careful patient selection and surgical adaptation are crucial for optimizing outcomes in complex Fontan procedures.
    • Further investigation into baffle design and management of associated anomalies may improve Fontan operation results.