• A Dore and J Somerville.
• Grown-up Congenital Heart Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, England. annie.dore@sympatico.ca
• Ann. Thorac. Surg. 2000 Jan 1; 69 (1): 181-5.

BackgroundThe right ventricle, when incorporated in the Fontan circulation, might enlarge and function as a pump to the pulmonary circulation. Experience has shown that over the long-term, this operation can be associated with major difficulties.MethodsThe late results, (13+/-6 years) after right atrioventricular connection as a Fontan modification, were reviewed in 14 patients with tricuspid atresia (11), ventricular septal-defect with small right ventricle (2), and double inlet left ventricle (1) to assess the long-term survival, the right ventricular size, and the need and timing of reoperations. Operations used a valved conduit (7), a valveless Dacron (E.L. Bard, Haverhill, PA) tube (5) and a direct right atrium-right ventricle anastomosis (2).ResultsDeath occurred in 5 by 8+/-5 years. Conduit obstruction occurred in 10 by 9+/-3 years equally in patients with valved (6 of 7) compared to patients with valveless conduits (4 of 5) and irrespective of right ventricular size (3 of 4 with enlarged right ventricle versus 4 of 6 with small ventricle). Patients with direct atrioventricular anastomosis had no obstruction. Reoperation was performed in 9 but failed to relieve the obstruction in 4 because of external compression (4) with or without thrombosis (1).ConclusionsRight atrioventricular connection as a Fontan modification can provide good early palliation, but is a poor long-term solution, as it is associated with a high incidence and difficulties in relieving the obstruction.

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