Aretrospective analysis of Fontan procedure and its sequence in tertiary care teaching hospital in southern India

Abstract

Introduction: The Fontan operation is usually the final palliative procedure in patients with univentricular heart. The objectives of this study were firstly to describe the clinical and hemodynamic characteristics of a group of patients with univentricular physiology who had previously been palliated with a right modified Blalock Taussig's Shunt, Bidirectional Glenn Shunt and secondly to identify the risk factors that can influence post-operative outcomes after Fontan operation. Materials and Methods: Aretrospective analysis of 20 patients who underwent Fontan operation between January 2005 to January 2014 was conducted. Clinical characteristics, catheterization data, type and duration of surgery were reviewed and analysed as predictors of post-operative outcome. Results: We operated 20 cases out of which 14 were males and 6 were females. The majority of the patients (10) were in the age group of 11-20 years. The diagnosis included double outlet right ventricle (DORV) 5 patients, ventricular septal defect with pulmonary stenosis 5 patients, transposition of great arteries (TGA) 3 patients, tricuspid atresia (TA) 6 patients and double inlet left ventricle with pulmonary stenosis (DILV, PS) 1 patient. Out of these, 4 patients were palliated with right modified Blalock-Taussig (BT) shunt, and 6 patients with Glenn Shunt. The rest were for the direct Fontan procedure. Two patients died during the postoperative period. Conclusion: The performance of hemodynamic study before Fontan operation made it possible to select high risk patients for surgery. Fontan operation showed dramatic improvements in symptoms and saturations.

Keywords

• fontan procedure
• univentricular heart
• cardiac catheterization