Noninvasive evaluations of pulmonary circulation, cardiac function, and liver excreting rate at late follow-up following the modified Fontan operation

Abstract

The purpose of this paper was to define the late postoperative pulmonary circulation and cardiac and liver functions after a modified Fontan operation by radionuclide studies. Eleven patients (5 with single ventricle and 6 with double outlet right ventricle) underwent a modified Fontan operation using a RA-PA anastomosis. These 11 patients ranging in age from 7 to 42 years (mean 17 ± 10 years) were examined at 4.7–12.1 years (mean 8.6 ± 2.4 years) postoperatively and compared with studies in 10 normal adults. Pulmonary circulation, cardiac function and liver excreting function were determined by intravenous administration of Tc-MAA, Tc-PYP, and Tc-PMT, respectively. No extrapulmonary radioactivity was detected by Tc-MAA lung perfusion in patients. Although the cardiac diastolic function of the patients remained normal, the systolic functions (EF = 46.4 ± 7.8%, 1/3EF = 11.2 ± 4.4%, PER = 1.93 ± 0.54/sec) of the patients were significantly decreased compared with those of normal controls (EF = 54.7 ± 4.7%, 1/3EF = 21.7 ± 2.1%, PER = 2.91 ± 0.4/sec), respectively. The mean level of MTT of the patients (9.4 ± 2.7 minutes) was also significantly prolonged compared with that of normal controls (6.1 ± 4.4 minutes). Some of these deteriorated parameters clearly related to higher age at operation and length of intervals since operation. These data suggest that the earlier surgical intervention by the Fontan operation is desired for the complex congenital cardiac anomalies.