**7. Conclusions**

258 Congenital Heart Disease – Selected Aspects

Based on this study we conclude that the Fontan operation is a safe with a mortality rate comparable to that reported in previously published large series (Our series 14.3%), which is shown in the table No. 2. The Mayo Clinic experience, shows a overall mortality after Fontan, of 16%, but Many factors may have contributed to decreased early mortality after Fontan. Improved patient selection, younger age at time of operation, refinements in surgical techniques and postoperative management may all have had important roles.

The evolution in the medium and long term outcome of patients operated with the original technique described by Fontan in the 70s demonstrated problems with the incorporation of all the systemic venous atrium in the circuit, characterized primarily by supraventricular arrhythmias and formation of thrombi (9,10,11). This is explained by atrial dilatation and inefficient circulation through this atrium which progressively becomes larger. But, changes in surgical techniques have been made to minimize these problems and improve long-term

At present there are different techniques for completion of the total cavopulmonary diversion: the intracardiac lateral tunnel (technique I) and extracardiac conduit (Technician II), which are the most widely used worldwide and are just two ways that we have employed. We have most often used the intracardiac lateral tunnel and extracardiac conduit including for those patients with abnormal systemic venous return and/or lung disease, which is usually seen in patients with heterotaxy syndrome. Regarding the use or non use of fenestration, this has also been the subject of much discussion, there are groups of surgeons that use the fenestration routinely and others who use it selectively (12,13). We are using this routinely in all our patients because pulmonary vascular resistance is a dynamic phenomenon and therefore it is not always easy to predict its behavior during the postoperative period. It seems safer for the patient having a fenestration that allows you to maintain adequate cardiac output during periods of high pulmonary vascular resistance, plus helps reduce the incidence of prolonged pleural effusions, resulting in decreased

With the passage of time have defined a number of criteria considered important for success in the performance of a Fontan-type surgery. These have included age, single ventricle morphology, anatomy of the pulmonary arteries, the atrioventricular valve function among

Kirklin and colleagues (15) reported 102 patients who had Fontan between 1975 and 1985. They found that age less than 4 years was a risk factor for mortality. Subsequently, the Children`s Hospital Boston reviewed 500 patients between 1973 and 1991 and found similar results in relation to age (16). As for the type of functional single ventricle, these techniques

I 48 85.7 96.4 II 1 1.8 98.2 not evaluated 7 12.5 100.0

Total 56 100.0

Table 5. Current functional class

**6. Discussion** 

outcome (9).

hospital length of stay (12,13)

others (14,15).

Frecuency Percentage Cumulative Percentage

Management strategies in cases of functional single ventricle have come to a group of procedures where the goal is to obtain a ventricular pressure and volume close to normal. This analytical cross-sectional, cohort analysis is meant to show expertise in the management protocol of univentricular patients by total cavopulmonary connection (Fontan operation.) in Cardiovascular Clinic Santa Maria in the city of Medellin. Based on this study we conclude that the Fontan operation is safe with a mortality rate comparable to previously published large series (14.3%); the results are independent of the type of ventricle and the hospital length of stay is short (average hospital stay of 13.9 days). Postoperatively, is that over 90% of patients were in functional class I - II.
