The Fontan Operation: Experience at Siriraj Hospital
JARUPIM SOONGSWANG, M.D.*,
API CHART NANA, M.D.*,
KRITVIKROM DURONGPISITKUL, M.D.*,
UNGKAB PRAKANRAITANA, M.D.***,
SIRILUCK SURlY ABANTHEONG, B.Sc. (RT)****,
BURIN KAOSA-ARD, B.Ed.****,
SAMPHANT PORNVILAWAN,M.D.**,
DUANGMANEE LAOHAPRASITIPORN, M.D.*,
SOMCHAI SRIYOSCHARTI, M.D.**,
CHARUWAN KANGKAGATE, B.Sc., M.S. (Biostat)****,
KANCHANA WANSANIT, B.Sc. (Nursing)****,
NITA Y A LIMPIMWONG, B.Sc. (Nursing)*
Affiliation : *Division of Cardiology, Department of Pediatrics,
** Division of Cardiovascular Surgery, Department of Surgery,
*** Department of Anesthesiology,
**** Her Majesty Cardiac Center, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok 10700. Thailand.
AbstractSeventy five patients underwent modified Fontan operation at Siriraj Hospital from
October 1987 to December 1998. Cardiology data was analyzed retrospectively. Four patients' data
was unavailable. Median age at operation was 9. 7 ( 1.8-34) years old . Tricuspid atresia accounted
for 38 per cent of the patients. Ten patients (14.1%) died in the acute post operative period due to
consequence of low cardiac output. Another 3 patients (4.2%) expired in the intermediate and late
post operative period. Age at operation, pulmonary artery size, pre-operative oxygen saturation, and
mean pre-operative pulmonary artery pressure were not different between those who survived
and those who died. Abnormal pulmonary vein, atrioventricular valve regurgitation, and underlying
ventricular morphology statistically affected the acute survival of modified Fontan operation.
Intraoperative aortic cross clamp time, and post operative mean pulmonary artery pressure on day
0, l and 2 post operation were found statistically shorter and lower in the survival group. Survival
rate at 5 years was 83 per cent. Modified Fontan operation is the final palliative operation of
choice for low risk single ventricle physiology in our institution with acceptable outcome. Thorough
pre-operative hemodynamic and anatomic studies and staging modified Fontan procedure may
include a higher number of candidates and improve the outcome of the operation.
Keywords : Fontan Operation, Complex Univentricular Heart
All Articles
Download
