Abstract
The Fontan procedure for hypoplastic left heart syndrome (HLHS) is well established. Multiple surgical techniques including extracardiac conduits and autologous tissue connections have been developed. We reviewed the results of 100 consecutive patients undergoing the lateral tunnel modification of the Fontan procedure at the University of Michigan. A cross-sectional retrospective study was performed for 100 consecutive patients identified in the University of Michigan Congenital Heart Surgery database with the diagnosis of HLHS. All patients had undergone a lateral tunnel Fontan procedure between June 2000 and August 2004. The medical record was reviewed to assess patient, procedural, and morphologic determinants of outcome. Hospital survival was 97% and intermediate-term survival was 96% with a median follow-up time of 34 months. Preoperative mean pulmonary artery pressure, right ventricular end diastolic pressure, aortic cross-clamp time, and tricuspid valve regurgitation were not associated with late right ventricular function or survival. Three patients required takedown of the lateral tunnel Fontan in the early postoperative period. A positive association was found between protein-losing enteropathy and prolonged (>2 weeks) postoperative pleural drainage (p = 0.035). No patient required cardiac transplantation or late intervention on the Fontan pathway. At the time of follow-up, 100% of patients were New York Heart Association class I or II and 90% were in normal sinus rhythm. The lateral tunnel Fontan procedure for HLHS can be performed with acceptable early and intermediate-term risk. There was a low prevalence of late rhythm disturbances and other complications. Protein-losing enteropathy and prolonged pleural drainage were associated.
References
Alphonso N, Baghai M, Sundar P, et al. (2005) Intermediate-term outcome following the Fontan operation: a survival, functional, and risk-factor analysis. Eur J Cardiothorac Surg 28:529–535
Bove EL (1998) Current status of staged reconstruction for hypoplastic left heart syndrome. Pediatr Cardiol 19:308–315
Bove EL, de Leval MR, Migliavacca F, et al. (2003) Computational fluid dynamics in the evaluation of hemodynamic performance of cavopulmonary connections after the Norwood procedure for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 126:1040–1047
Bove EL, Lloyd TR (1996) Staged reconstruction for hypoplastic left heart syndrome, contemporary results. Ann Surg 224:387–394
Bove EL, Mosca RS (1996) Surgical repair of the hypoplastic left heart syndrome. Prog Pedeatr Cardiol 5:23–35
Bove EL, Ohye RG, Devaney EJ (2004) Hypoplastic left heart syndrome: conventional surgical management. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 7:3–10
de Leval MR, Kilner P, Gewillig M, Bull C (1988) Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg 96:682–695
Douglas WI, Goldberg CS, Mosca RS, et al. (1999) Hemi-Fontan procedure for hypoplastic left heart syndrome: outcome and suitability for Fontan. Ann Thorac Surg 68:1361–1367
Durongpisitkul K, Porter CJ, Cetta F, et al. (1998) Predictors of early- and late-onset supraventricular tachyarrhythmias after Fontan operation. Circulation 98:1099–1107
Feldt RH, Driscoll DJ, Offord KP, et al. (1996) Protein-losing enteropathy after the Fontan operation. J Thorac Cardiovasc Surg 112:672–680
Fontan F, Baudet E (1971) Surgical repair of tricuspid atresia. Thorax 26:240–248
Goldberg CS, Schwartz EM, Brunberg JA, et al. (2000) Neurodevelopmental outcome of patients after the Fontan operation: a comparison between children with hypoplastic left heart syndrome and other functional single ventricle lesions. J Pediatr 137:646–652
Jonas RA, Castaneda AR (1988) Modified Fontan procedure: atrial baffle and systemic venous to pulmonary artery anastomotic techniques. J Card Surg 3:91–96
Kaulitz R, Ziemer G, Luchmer I, et al. (1996) Modified Fontan operation in functionally univentricular hearts: preoperative risk factors and intermediate results. J Thorac Cardiovasc Surg 112:658–669
Mayer JE Jr, Bridges N, Lock K, et al. (1992) Factors associated with marked reduction in mortality for Fontan operations in patients with single ventricle. J Thorac Cardiovasc Surg 103:444–452
Mosca RS, Kulik TJ, Goldberg CS, et al. (2000) Early results of the Fontan procedure in one hundred consecutive patients with hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 119:1110–1118
Nurnberg JN, Ovroutski S, Alexi-Meskishvili V, et al. (2004) New onset arrhythmias after the extracardiac conduit Fontan operation compared with the intra-atrial lateral tunnel procedure: early and midterm results. Ann Thorac Surg 78:1979–1988
Ohye RG, Gomez CA, Goldberg CS, et al. (2004) Tricuspid valve repair in hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 127:465–472
Stamm C, Friehs I, Mayer JE Jr, et al. (2001) Long-term results of the lateral tunnel Fontan operation. J Thorac Cardiovasc Surg 122:1219–1228
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hirsch, J.C., Ohye, R.G., Devaney, E.J. et al. The Lateral Tunnel Fontan Procedure for Hypoplastic Left Heart Syndrome: Results of 100 Consecutive Patients. Pediatr Cardiol 28, 426–432 (2007). https://doi.org/10.1007/s00246-007-9002-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-007-9002-5