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The Journal of Thoracic and Cardiovascular Surgery, Vol 92, 1021-1028, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JE Mayer Jr, H Helgason, RA Jonas, P Lang, FJ Vargas, N Cook and AR Castaneda
During the early development of atriopulmonary anastomotic operations
(Fontan-Kreutzer), a number of physiologic and anatomical limits were
proposed by the Fontan group as selection criteria. Among 167 consecutive
patients undergoing modified Fontan procedures from 1973 through 1985, 109
(65%) patients exceeded one or more of the original selection criteria in
areas of age, anomalies of systemic or pulmonary venous connection,
pulmonary artery distortion, and pulmonary artery pressure. Twenty-six
patients had a mean pulmonary artery pressure greater than 15 mm Hg, with
16 operative survivors (62%). Nineteen patients had anomalies of systemic
and/or pulmonary venous connection, and 16 survived (84%). There were 44
patients under the age of 4 years, and 26 survived (59%). Twenty-five
patients were older than 15 years, and 23 (92%) survived the Fontan
procedure. Pulmonary artery distortion, relating to prior palliative
operations, was found in 34 patients. Seventeen of these 34 survived a
modified Fontan procedure (50%). Twenty-six patients had a pulmonary
arteriolar resistance more than 2 Wood units times square meter, and 14
survived (54%), whereas 81 of 93 with a pulmonary arteriolar resistance of
less than 2 U X m2 survived (87%). Multivariate analysis showed that
pulmonary arteriolar resistance and pulmonary artery distortion had a
significant, negative impact on survival, but age and anomalies of systemic
and/or pulmonary venous connection did not. Pulmonary artery pressure was
not an independent predictor of outcome. The results show that the original
criteria may be exceeded in the areas of age and anomalies of pulmonary or
systemic venous connection. Pulmonary artery pressure alone should not
contraindicate a Fontan procedure if pulmonary arteriolar resistance is
low. Pulmonary artery distortion from a prior palliative operation and
elevated pulmonary arteriolar resistance increase the risk of a Fontan
procedure.
ARTICLES
Extending the limits for modified Fontan procedures
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M. D. Rodefeld, J. H. Boyd, C. D. Myers, B. J. LaLone, A. J. Bezruczko, A. W. Potter, and J. W. Brown Cavopulmonary assist: circulatory support for the univentricular fontan circulation Ann. Thorac. Surg., December 1, 2003; 76(6): 1911 - 1916. [Abstract] [Full Text] [PDF]
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S. P. McGuirk, D. S. Winlaw, S. M. Langley, O. F. Stumper, J. V. de Giovanni, J. G. Wright, W. J. Brawn, and D. J. Barron The impact of ventricular morphology on midterm outcome following completion total cavopulmonary connection Eur. J. Cardiothorac. Surg., July 1, 2003; 24(1): 37 - 46. [Abstract] [Full Text] [PDF]
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T. Hiramatsu, Y. Imai, H. Kurosawa, Y. Takanashi, M. Aoki, T. Shin'oka, and M. Nakazawa Effects of dilutional and modified ultrafiltration in plasma endothelin-1 and pulmonary vascular resistance after the Fontan procedure Ann. Thorac. Surg., March 1, 2002; 73(3): 862 - 865. [Abstract] [Full Text] [PDF]
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M. Levy, C. Danel, D. Tamisier, P. Vouhe, and F. Leca Histomorphometric analysis of pulmonary vessels in single ventricle for better selection of patients for the Fontan operation J. Thorac. Cardiovasc. Surg., February 1, 2002; 123(2): 263 - 270. [Abstract] [Full Text] [PDF]
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N. Yoshimura, M. Yamaguchi, Y. Oshima, S. Oka, Y. Ootaki, T. Tei, and S. Kido Risk factors influencing early and late mortality after total cavopulmonary connection Eur. J. Cardiothorac. Surg., September 1, 2001; 20(3): 598 - 602. [Abstract] [Full Text] [PDF]
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G R Veldtman, A Nishimoto, S Siu, M Freeman, P M Fredriksen, M A Gatzoulis, W G Williams, and G D Webb The Fontan procedure in adults Heart, September 1, 2001; 86(3): 330 - 335. [Abstract] [Full Text] [PDF]
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T. Bove, H. Demanet, H. Dessy, P. Viart, and F. E. Deuvaert Cavopulmonary connection after repair of pulmonary vein stenoses Ann. Thorac. Surg., February 1, 2001; 71(2): 725 - 727. [Abstract] [Full Text] [PDF]
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G. K.T. Iyer, G. S. Van Arsdell, F. P. Dicke, B. W. McCrindle, J. G. Coles, and W. G. Williams Are bilateral superior vena cavae a risk factor for single ventricle palliation? Ann. Thorac. Surg., September 1, 2000; 70(3): 711 - 716. [Abstract] [Full Text] [PDF]
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G. S. Van Arsdell, B. W. McCrindle, K. D. Einarson, K.-J. Lee, E. Oag, C. A. Caldarone, and W. G. Williams Interventions associated with minimal Fontan mortality Ann. Thorac. Surg., August 1, 2000; 70(2): 568 - 574. [Abstract] [Full Text] [PDF]
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K. Bando, M. W. Turrentine, H. J. Park, T. G. Sharp, V. Scavo, and J. W. Brown Evolution of the Fontan procedure in a single center Ann. Thorac. Surg., June 1, 2000; 69(6): 1873 - 1879. [Abstract] [Full Text] [PDF]
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R. S. Mosca, T. J. Kulik, C. S. Goldberg, R. P. Vermilion, J. R. Charpie, D. C. Crowley, and E. L. Bove EARLY RESULTS OF THE FONTAN PROCEDURE IN ONE HUNDRED CONSECUTIVE PATIENTS WITH HYPOPLASTIC LEFT HEART SYNDROME J. Thorac. Cardiovasc. Surg., June 1, 2000; 119(6): 1110 - 1118. [Abstract] [Full Text] [PDF]
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T. Hiramatsu, Y. Imai, Y. Takanashi, K. Seo, M. Terada, M. Aoki, and M. Nakazawa Time course of endothelin-1 and adrenomedullin after the Fontan procedure Ann. Thorac. Surg., July 1, 1999; 68(1): 169 - 172. [Abstract] [Full Text] [PDF]
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R. M. Freedom and G. S. Van Arsdell Biventricular hearts not amenable to biventricular repair Ann. Thorac. Surg., August 1, 1998; 66(2): 641 - 643. [Abstract] [Full Text] [PDF]
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T. Hiramatsu, Y. Imai, Y. Takanashi, K. Seo, M. Terada, and M. Nakazawa Hemodynamic Effects of Human Atrial Natriuretic Peptide After Modified Fontan Procedure Ann. Thorac. Surg., March 1, 1998; 65(3): 761 - 764. [Abstract] [Full Text]
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C. H. Zachary, M. L. Jacobs, S. Apostolopoulou, and M. A. Fogel One-Lung Fontan Operation: Hemodynamics and Surgical Outcome Ann. Thorac. Surg., January 1, 1998; 65(1): 171 - 175. [Abstract] [Full Text] [PDF]
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T. L. Gentles, J. E. Mayer, Jr., K. Gauvreau, J. W. Newburger, J. E. Lock, J. P. Kupferschmid, J. Burnett, R. A. Jonas, A. R. Castaneda, and G. Wernovsky FONTAN OPERATION IN FIVE HUNDRED CONSECUTIVE PATIENTS: FACTORS INFLUENCING EARLY AND LATE OUTCOME J. Thorac. Cardiovasc. Surg., September 1, 1997; 114(3): 376 - 391. [Abstract] [Full Text]
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T. L. Gentles, K. Gauvreau, J. E. Mayer Jr., S. B. Fishberger, J. Burnett, S. D. Colan, J. W. Newburger, and G. Wernovsky FUNCTIONAL OUTCOME AFTER THE FONTAN OPERATION: FACTORS INFLUENCING LATE MORBIDITY J. Thorac. Cardiovasc. Surg., September 1, 1997; 114(3): 392 - 403. [Abstract] [Full Text]
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D. B. McElhinney, V. M. Reddy, P. Moore, and F. L. Hanley Bidirectional Cavopulmonary Shunt in Patients With Anomalies of Systemic and Pulmonary Venous Drainage Ann. Thorac. Surg., June 1, 1997; 63(6): 1676 - 1684. [Abstract] [Full Text]
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R. N. Gates, H. Laks, D. C. Drinkwater Jr, L. Lam, A. Blitz, J. S. Child, and J. K. Perloff The Fontan Procedure in Adults Ann. Thorac. Surg., April 1, 1997; 63(4): 1085 - 1090. [Abstract] [Full Text]
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J. S. Tweddell, S. Berger, P. C. Frommelt, A. N. Pelech, D. A. Lewis, R. T. Fedderly, M. A. Frommelt, T. S. McManus, Ccp, K. A. Mussatto, et al. Aprotinin Improves Outcome of Single-Ventricle Palliation Ann. Thorac. Surg., November 1, 1996; 62(5): 1329 - 1335. [Abstract] [Full Text]
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K. Miyaji, M. Shimada, A. Sekiguchi, A. Ishizawa, and T. Isoda Usefulness of Pulsatile Bidirectional Cavopulmonary Shunt in High-Risk Fontan Patients Ann. Thorac. Surg., March 1, 1996; 61(3): 845 - 850. [Abstract] [Full Text]
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R. Sharma, K. S. Iyer, B. Airan, K. Saha, B. Das, A. Bhan, I. M. Rao, P. Venugopal, and S. b. R. A. Jonas UNIVENTRICULAR REPAIR: Early and midterm results J. Thorac. Cardiovasc. Surg., December 1, 1995; 110(6): 1692 - 1701. [Abstract] [Full Text]
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M. Rubino, S. V. Praagh, K. Kadoba, R. Pessotto, and R. V. Praagh Systemic and pulmonary venous connections in visceral heterotaxy with asplenia: Diagnostic and surgical considerations based on seventy-two autopsied cases J. Thorac. Cardiovasc. Surg., September 1, 1995; 110(3): 641 - 650. [Abstract] [Full Text]
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H. Laks, A. Ardehali, P. W. Grant, L. Permut, A. Aharon, M. Kuhn, J. Isabel-Jones, and A. Galindo Modification of the Fontan Procedure : Superior Vena Cava to Left Pulmonary Artery Connection and Inferior Vena Cava to Right Pulmonary Artery Connection With Adjustable Atrial Septal Defect Circulation, June 15, 1995; 91(12): 2943 - 2947. [Abstract] [Full Text]
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C. J. Knott-Craig, G. K. Danielson, H. V. Schaff, F. J. Puga, A. L. Weaver, and D. D. Driscoll The modified fontan operationAn analysis of risk factors for early postoperative death or takedown in 702 consecutive patients from one institution J. Thorac. Cardiovasc. Surg., June 1, 1995; 109(6): 1237 - 1243. [Abstract] [Full Text]
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M. Aoki, J. M. Forbess, R. A. Jonas, J. E. Mayer Jr., and A. R. Castaneda Result of biventricular repair for double-outlet right ventricle J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 338 - 350. [Abstract] [Full Text]
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