European Journal of Cardio-Thoracic Surgery, Vol 2, 393-404, Copyright © 1988 by European Association for Cardio-thoracic Surgery
The modified Fontan operation for double inlet left ventricle. Surgical results, early haemodynamic and functional assessment
G Crupi, M Carminati, A Borghi, V Vanini and L Parenzan
Department of Cardiac Surgery, Ospedali Riuniti di Bergamo, Italy.
Twenty-one patients with a double inlet left ventricle underwent a modified
Fontan between May 1979 and August 1987. All but the first patient in this
series were operated upon after August 1984. Their age at operation ranged
from 4 to 23 years with a median age of 8 years. Initial palliation was
required in 12 patients and the mean interval to repair was 77.1 months,
ranging from 38 to 112. Only one of the criteria of Choussat was exceeded
in 12 patients. The pulmonary vascular resistance was always less than 4
Um2. A direct atriopulmonary anastomosis was performed in 19 patients and
an aortic homograft interposition was used in 2. There was one hospital
death due to acute cardiac failure and no late deaths. The average of the
mean right and left atrial pressures measured early postoperatively was
12.9 and 8 mmHg respectively. A prolonged hospitalization with a mean of 23
days, ranging from 9 to 69, was required because of recurrent pleural and
pericardial effusions which usually resolved after the first 6
postoperative months. The need for early anticoagulation is recommended to
prevent the risk of pulmonary thromboembolism observed in 2 of our
patients. Cardiac catheterization performed in 19 patients within 1 year
after surgery showed that the average of the mean right atrial pressure had
decreased to 11.3 mmHg without a gradient across the anastomosis in any
case. Two patients required reoperation: one for enlargement of a
restrictive ventricular septal defect and the other for closure of a
recurrent dehiscence of the patch used for closure of the right a-v valve.
Three patients developed a significant subaortic obstruction and have been
scheduled for reoperation. Ventricular function was assessed at a mean
interval of 11.9 months (17 patients) and 25.5 months (13 patients) from
surgery. Gated equilibrium radionuclide ventriculography showed that the
ejection fraction was normal (greater than or equal to 50%) and it had
increased with time in 10. Yet, the response to exercise was normal in only
5 of the 13 patients re-evaluated. Treadmill exercise testing showed an
increase in exercise tolerance from a mean of 7.4 min to a mean of 8.7
min.(ABSTRACT TRUNCATED AT 400 WORDS)
