Staged Fontan Operation Via Bidirectional Glenn Operation

Han, Jae Jin; Kim, Woong Han; Chung, Cheol Hyun; Jung, Yoon Seop; Lee, Yeong Tak; Park, Young Kwan; Bae, Eun Jeong; Kim, Seong Ho

Abstract

From August 1989 to January 1996, a total of 105 cases of bidirectional Glenn operations have been done as the interim stage for the patients with some risk of univentricular correction at Sejong General Hospital. From December 1992, we started the conversion to Fontan operations for them, and 42 cases underwent Fontan-stage operation till February 1996. Their diagnoses were univentricular heart in 19(right ventricular type : 14), tricuspid atresia 11, double outlet of right ventricle 9, and others in 3 cases. The median age of bidirectional Glenn-stage operation was 12.5 months(range 2 months to 8 years) and Fontan-stage operation was at 59.6 months of median age(range 1 year 5 months to 9 year 7 months). The mean waiting interval between the two operations was 33.88+/-17.85 months with a range of 10 months to 6 years 3 months. During the waiting periods, 18 patients developed significant systemic-pulmonary collaterals and/or systemic veno-veno collateral channels. There were 5 hospital deaths after operations due to low cardiac output in 4 and sepsis in one. Most of the Fontan-stage operations were done by the lateral tunneling with Gore-Tex tube graft patch and fenestrated with the size of 2.5~6 mm. All the patients were followed-up(7 months to 4 years 2 months, mean 21.97+/-10.82 months) and there were 5 late deaths(postoperatively 6 months to 2 years) due to thromboembolism in 1, after heart transplantation 1, plastic bronchitis 1, protein loosing enteropathy 1, and pneumonia in 1. Dividing the patients by the waiting interval of 2 years, the early correction to Fontan group (N=16) showed the better results(hospital mortality 1/16, late mortality 1/16, significant collateral development 2/16) compared to the other group(N=26) (4/26, 4/26, 16/26). In conclusion, after the bidirectional Glenn-stage operation successfully got rid of the previous risk factors, we recommand to do the Fontan-stage operation no later than 2 years of interval.