The Journal of Thoracic and Cardiovascular Surgery, Vol 85, 447-450, Copyright © 1983 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Modified Fontan procedure in patients with previous ascending aorta- pulmonary artery anastomosis
G Uretzky, FJ Puga and GK Danielson
The Fontan procedure has proved useful in the surgical treatment of
patients with tricuspid atresia, univentricular heart, and other
complicated cardiac anomalies. Previous palliation of these patients with
ascending aorta-right pulmonary artery anastomosis (Waterston shunt) may
impose severe restrictions in the operability of these patients because of
severe distortion, narrowing, and scarring of the proximal right pulmonary
artery. A modification of the Fontan operation is described in which repair
is facilitated by transecting the right pulmonary artery at the site of
anastomosis, trimming away the distorted narrowed segment, and anastomosing
the resulting cuff to the lateral aspect of the superior vena cava. The
right atrial appendage is anastomosed to the rudimentary right ventricle or
the main pulmonary artery directly or via a tubular Dacron graft. The
technique has been applied successfully in four consecutive cases.
