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Morphology of hearts undergoing Fontan repair

Published online by Cambridge University Press:  19 August 2008

Vivek Murari ,
Rajesh Sharma ,
Balram Airan ,
Anil Bhan ,
Shiv K. Choudhary ,
Anita Saxena ,
Shyam S. Kothari ,
Subhash C. B. Reddy  and
Panangipalli Venugopal
Vivek Murari
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Rajesh Sharma*
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Balram Airan
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Anil Bhan
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Shiv K. Choudhary
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Anita Saxena
Affiliation:
Department of CardiologyCardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Shyam S. Kothari
Affiliation:
Department of CardiologyCardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Subhash C. B. Reddy
Affiliation:
Department of CardiologyCardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Panangipalli Venugopal
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
*
Dr Rajesh Sharma, Associate Professor, Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi 110 029, India Tel 91-11 - 661123, 6864851 - Extn # 4835, Fax 91-11 - 6862663
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Abstract

Background

Notwithstanding the controversies evoked by the term “single ventricle”, most patients with this condition would undergo the Fontan procedure. In addition, there is a large group of patients in whom a biventricular repair would be abandoned in favour of a univentricular one because of the presence of unfavourable morphologic features. There is a need for a uniformly acceptable system of nomenclature that would permit precise description and classification of hearts with complex malformations to facilitate reporting and help in understanding the reasons for choosing a univentricular repair.

Methods

Echocardiographic, angiographic and operative records of 240 patients undergoing the Fontan procedure were analysed.

Results

Out of the 104 patients with univentricular atrioventricular connections, 2 ventricles were discernible in all but 3 patients. A Fontan repair was performed in 136 patients with biventricular atrioventricular connections because of the presence of a hypoplastic ventricle in 52 patients and a non-committed ventricular septal defect in the remaining 84.

Conclusions

The Fontan operation is probably the only definitive treatment option for patients with univentricular atrioventricular connections. The decision to perform a univentricular repair in preference to a biventricular one in hearts with biventricular atrioventricular connections is based on the presence of a hypoplastic ventricle or a non-reroutable ventricular septal defect. This decision is subjective. In hearts with discordant atrioventricular connections and pulmonary stenosis, we prefer the Fontan operation to the classical repair.

Keywords

Fontan procedureheart defects, congenitalheart bypass, right
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 2 , April 1998 , pp. 165 - 171
Copyright
Copyright © Cambridge University Press 1998

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