PMID- 15063262
OWN - NLM
STAT- MEDLINE
DCOM- 20040506
LR  - 20071115
IS  - 0003-4975 (Print)
IS  - 0003-4975 (Linking)
VI  - 77
IP  - 4
DP  - 2004 Apr
TI  - Improved early results with the Fontan operation in adults with functional single 
      ventricle.
PG  - 1334-40
AB  - BACKGROUND: A growing number of adults with functional single ventricles are 
      presenting as candidates for first-time and redo-Fontan operations. This study 
      describes the clinical presentation and early operative results of adults who 
      have undergone Fontan modifications. METHODS: Between July 1995 and April 2003, 
      23 patients (>18 years old) had Fontan operations. We retrospectively reviewed 
      their perioperative courses. RESULTS: Twenty-three Fontan operations (first-time 
      [n = 8] and redo [n = 15]) were performed with no early or late deaths. No 
      patient has required reoperation. One patient has been listed for orthotopic 
      heart transplantation. The overall mean age is 23 years (18 to 41 years); mean 
      follow-up, 30 months; median postoperative hospital stay, 8 days (4 to 34 days); 
      and median duration of chest tube drainage, 4 days (2 to 12 days). The 
      postoperative New York Heart Association (NYHA) functional class was improved in 
      22 of 23 patients. Eight first-time Fontan operations (7 of 8 nonfenestrated) 
      were performed; lateral tunnel (n = 7) and extracardiac conduit (n = 1). Two 
      patients had preoperative arrhythmias. New onset arrhythmias (ventricular 
      tachycardia and sinus node dysfunction), requiring treatment, occurred in two 
      patients. Fifteen redo-Fontan operations (all nonfenestrated) were performed; 
      lateral tunnel (n = 5) and extracardiac conduit (n = 10). Fifteen patients had 
      preoperative arrhythmias, thirteen of which had intraatrial reentry tachycardia 
      (IART) and required antiarrhythmic medications. Concomitant intraoperative 
      radiofrequency ablation (RFA) (n = 11) and cryoablation (n = 1) procedures were 
      performed. In the immediate postoperative period, there was IART recurrence in 
      five patients (post-RFA [n = 4] and postcryoablation [n = 1]). At latest 
      follow-up, no patient is being treated with antiarrhythmic medications. Two 
      patients had new onset atrial arrhythmias that required treatment. CONCLUSIONS: 
      The Fontan operation can be performed in adults with minimal morbidity and 
      improved NYHA functional class. New onset arrhythmias requiring treatment are 
      sources of perioperative morbidity. Complete arrhythmia resolution of the 
      preoperative arrhythmia may not be achieved in the immediate postoperative period 
      in redo-Fontan patients. However, modification (intraoperative radiofrequency 
      ablation-right atrial debulking) of the atrial tachycardia circuits in the 
      redo-Fontan patients can result in complete resolution of preoperative atrial 
      tachyarrhythmias at early follow-up.
FAU - Mott, Antonio R
AU  - Mott AR
AD  - Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 
      Houston 77030, USA. amott@bcm.tmc.edu
FAU - Feltes, Timothy F
AU  - Feltes TF
FAU - McKenzie, E Dean
AU  - McKenzie ED
FAU - Andropoulos, Dean B
AU  - Andropoulos DB
FAU - Bezold, Louis I
AU  - Bezold LI
FAU - Fenrich, Arnold L
AU  - Fenrich AL
FAU - Bedford, Shannon L
AU  - Bedford SL
FAU - El-Said, Howaida
AU  - El-Said H
FAU - Stayer, Stephen A
AU  - Stayer SA
FAU - Fraser, Charles D Jr
AU  - Fraser CD Jr
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Arrhythmias, Cardiac/complications
MH  - Echocardiography
MH  - *Fontan Procedure
MH  - Heart Defects, Congenital/complications/pathology/surgery
MH  - Heart Ventricles/*abnormalities
MH  - Humans
MH  - Postoperative Complications
MH  - Reoperation
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2004/04/06 05:00
MHDA- 2004/05/07 05:00
CRDT- 2004/04/06 05:00
PHST- 2003/10/02 00:00 [accepted]
PHST- 2004/04/06 05:00 [pubmed]
PHST- 2004/05/07 05:00 [medline]
PHST- 2004/04/06 05:00 [entrez]
AID - S000349750302023X [pii]
AID - 10.1016/j.athoracsur.2003.10.011 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2004 Apr;77(4):1334-40. doi: 10.1016/j.athoracsur.2003.10.011.