Some patients who underwent conventional Fontan operation with atriopulmonary connection(APC), tend to present exercise intolerance, thromboembolic events and refractory arrhythmia with time.
(Objective)
We examined surgical outcome and late results in post Fontan patient with APC and efficacy of Total cavopulmonary connection (TCPC) conversion.
(Method)
Fifteen patients, ranged 2.5~ 12.6 years old(mean 8.2)at Fontan, with tricuspid atresia (n=11), single ventricle and pulmonary atresia (n=2, each).underwent APC between March 1978 and January 1995. Seven patients had conversion to TCPC. Interval period between initial Fontan and conversion was 12.1 year in average. There were six patients followed for more than 20 years.
Indication for conversion were pulmonary emboli (n=2), Fontan pathway obstruction including conduit stenosis (n=4) and atrial dysrhythmia(n=1). All patients underwent the conversion to TCPC with an extracardiac conduit and the right atrial reduction plasty, while PV isolation was performed in two patients.
(Results)
There were 5 late deaths including two non cardiac related deaths due to post transfusion hepatitis. Actuarial survival rate and Freedom from reintervention were 66.8% and 51.9% respectively at 20 years.
Postconversion central venous pressure decreased significantly from 18.8 to 13.8mmHg.
Exercise performance improved from grade3.0 to 2.0 in NYHA functional class. Three of five patients with atrial dysrhythmia converted to sinus rhythm postoperatively in conversion cases.
(Conclusion)
Surgical outcome of Conversion to TCPC was satisfactory and it led clinical improvement by decreasing right atrial preload. In untreated post Fontan patients, the conversion should be undertaken prior to clinical signs of chronic rhythm disturbances or exercise impairment.