INTRODUCTION
Fontan Procedure (FP) had been a hope for many patients with congenital
heart diseases (CHD) when Dr. Francis Fontan (July
2nd, 1929 – January 14th, 2018)
reported this technique for the first time in 1971 [1]. In this
original report, the FP was carried out in three patients with the
diagnosis of tricuspid atresia (TA). The right side of the heart was
bypassed with the combination of a classical cavopulmonary anastomosis
between the superior vena cavae and right pulmonary artery and
channeling the inferior venae cavae to left pulmonary artery with
interposing a homograft [2]. In his original paper, Dr. Fontan
emphasized the importance of well-developed pulmonary arteries with a
low pressure for the success of this operation.
In the following decades, the technique was further developed and
modified and on the other hand, the indications were hugely extended to
a variety of CHD with various morphologies. Probably the most important
evolutions in FP were the total cavopulmonary connection either with a
lateral tunnel or an extracardiac conduit and the idea of fenestration
[3-5]. In the current era of cardiac surgery, the potential
candidates for a Fontan procedure include a variety of CHD with one
well-developed ventricle or not [6].
Early after describing FP, Dr. Fontan and his colleague Dr. Choussat
reported the criteria for an ‘ideal’ Fontan candidate (table-1) [7].
These guidelines, or namely ‘the 10 commandments’ were revised
and modified during the following decades, since all the criteria were
not necessarily portending excellent long-term survival when statistical
analysis were concerned [8,9]. Today, mean pulmonary artery pressure
(MPAP) and ventricular function are probably the most prevailing
criteria for selecting a patient before constituting a Fontan
circulation.
Herein, we aimed to present our experience in 16 patients with a MPAP
over 15 mmHg who underwent Fontan operation. We also discussed some
aspects of mandatory criteria for a satisfactory outcome after FP with
regard to the data reported in literature.