Application of modified Fontan procedure (total cavopulmonary anastomosis) for correction of 47 children with complicated congenital heart diseases

Abstract

Objective: To summarize experiences of application of modified Fontan procedure (total cavopulmonary anastomosis) for correction of complicated congenital heart diseases in 47 children. Methods: 47 patients with complicated heart disease received modified Fontan procedure. Their age ranged 1.4～14.0 years. The body weight was 9～42 kg. The heart anomalies included tricuspid atresia in 10 patients, single ventricle in 17, double outlet of right ventricle in 14, transposition of the great arteries in 2 and corrected transposition of the great arteries in 4. Results: The operative mortality rate was 19.1%(9/47). Before 1995, the mortality was 26.3%(5/19), and after 1995 (including 1995) was 14.3%(4/28). One case died lately. Conclusion: The indication of modified Fontan procedure is widely extended including a variety of cyanotic complicated congenital heart diseases with only a single functional ventricular chamber in corrigible anatomically. To improve the operative results, the indication must be strictly considered. A baffle fenestration will lower caval and right atrial pressure, decrease pleural drainage, Shorten hospital stay and maintain cardiac output. For patients with refractory low cardiac output after Fontan circulation, an early and prompt reoperation to convert the circulation to a bidirectional cavopulmonary shunt (hemi-Fontan procedure) should be considered.