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(Circulation. 2008;117:13-15.)
© 2008 American Heart Association, Inc.

Editorial

Fontan Operation After 3 Decades

What We Have Learned

Welton M. Gersony, MD

From the Morgan Stanley Children’s Hospital of New York Presbyterian, New York, NY.

Correspondence to Welton M. Gersony, MD, Children’s Hospital of New York, 3959 Broadway, 2 North, Room 263, New York, NY 10032. E-mail wmgl@columbia.edu

Key Words: Editorials • follow-up studies • mortality • Fontan procedure

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The Fontan operation was designed to provide blood flow in series to the pulmonary and systemic circulation without the requirement for a right ventricular pumping chamber. The operation allows systemic venous blood to flow directly into the pulmonary circulation on the basis of a single ventricular impetus through the arteries, capillaries, and systemic venous system. This arrangement has improved life expectancy for patients with single-ventricle and pulmonary-outflow obstruction compared with previous arterial shunts. The long-term effects of marked single-ventricle preload and inefficient oxygenation via an arterial shunt rarely allowed survival beyond the second or third decade of life. Remarkably, the Fontan operation has become the most common procedure performed for congenital heart disease after the age of 2 years. Over the past 3 decades, the early and intermediate prognoses for patients who have undergone this operation have been improving as a result of useful refinements in the surgical procedure that have been introduced since Fontan’s original direct right atrium–to–pulmonary artery (RA-PA) connection. Furthermore, the indications for the operation have broadened considerably compared with the relatively few patients thought to be eligible in the late 1970s and 1980s.

Article p 85

The ultimate test of any surgical procedure is the long-term status of the postoperative patients. The article by Khairy and associates¹ in this issue of Circulation provides insight into the survival of the earliest generation of Fontan patients and allows assessment of the impact of management and surgical variations that have evolved over the past 3 decades on mortality. However, . . . [Full Text of this Article]

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