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Results of an extracardiac pericardial-flap lateral tunnel Fontan operation

^a Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Republic of Korea
^b Department of Pediatrics, Yonsei University, College of Medicine, Republic of Korea

Received 13 September 2007; received in revised form 16 April 2008; accepted 28 April 2008.

^_* Corresponding author. Address: Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Medical Center, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea. Tel.: +82 2228 8480; fax: +82 2313 2992. (Email: yhpark{at}yuhs.ac).

Objective: Extracardiac pericardial-flap lateral tunnel Fontan operation has the theoretical advantage of growth potentiality of the extracardiac tunnels. The mid-term results of this technique and morphologic change of the lateral tunnel were studied. Methods: Clinical data were reviewed in 42 patients who underwent extracardiac pericardial-flap lateral tunnel Fontan operation between November 1993 and December 2004. The age was 2.8 ± 1.5 years and the body weight was 12.3 ± 3.2 kg. Extracardiac tunnel was constructed using the pedicled pericardium with the base undetached. By reviewing the follow-up cardiac angiograms (2.3 ± 1.4 years postoperatively), ratios of diameter and cross-sectional area of the lateral tunnel to those of inferior vena cava were obtained. Results: There were 4 surgical mortalities (10%). Postoperative morbidity included prolonged pleural effusion in 5 patients and heart block in 1 patient. Follow-up was possible in 37 patients and the follow up duration was 3.8 ± 2.2 years. There were two late deaths due to ventricular dysfunction and sudden death of unknown causes. Two patients required reoperation due to subaortic stenosis and stenosis between inferior vena cava and lateral tunnel. In one patient, bradyarrhythmia was observed but there was no thromboembolic complication. Follow-up anteroposterior and lateral diameter ratio were 1.1 ± 0.5 and 1.2 ± 0.5. The cross-sectional area ratio was 2.6 ± 2.3. In 5 patients, fusiform dilatation of the lateral tunnel was observed, but in the remaining patients, the lateral tunnel preserved tubular morphology with good hemodynamics. Conclusions: Extracardiac pericardial-flap lateral tunnel Fontan operation is relatively simple and feasible even in patients with previous median sternotomies. The mid-term results were acceptable, and the lateral tunnel demonstrated a tendency to preserve its tubular shape. However in some patients, dilatation of the pericardial-flap tunnel was observed during follow up. Longer follow-up is required to determine the morphologic changes of the lateral tunnel and the value of this technique.

Key Words: Congenital heart defect • Hemodynamics • Pericardium • Outcome assessment • Fontan operation