• H A Hennein, H T Kililtan, and R M Sade.
• Section of Pediatric Cardiac Surgery, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
• Ann. Thorac. Surg. 1995 Dec 1; 60 (6 Suppl): S568-71.

BackgroundArrhythmias occur frequently after Fontan operations, and are related in part to high atrial pressure, wall distention, and scarring caused by extensive suture lines. These arrhythmic factors may be avoided by an extracardiac total cavopulmonary anastomosis. We have embarked on a program of conversion of the hemi-Fontan operation to a fenestrated extracardiac Fontan procedure with a relatively simple operation.MethodsIn a 4-month period ending in December 1994, 4 consecutive patients underwent this procedure. The inferior vena cava was divided and the cardiac end was oversewn. A large (20 to 25 mm) ascending aortic homograft, from which the inlet portion and valve had previously been excised, was interposed between the divided distal end of the inferior vena cava and the hood of the superior cavopulmonary anastomosis. A 4-mm fenestration with a pursestring snare mechanism was placed within the cavoatrial patch that had been implanted at the time of the hemi-Fontan procedure.ResultsThere were no deaths, and the average length of stay was 12 +/- 4 days (range, 8 to 18 days). In early follow-up, there have been no atrial arrhythmias, and three of the four fenestrations have been documented to be patent.ConclusionsAn extracardiac fenestrated Fontan procedure can safely and successfully be performed after a hemi-Fontan operation, and may have both hemodynamic and arrhythmic benefits.

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