During the more than 3 decades that have transpired since the earliest reports of “corrective surgery” for tricuspid atresia by Fontan and Baudet1 and Kreutzer and colleagues,2 the general principles of their operations have increasingly been applied to a wide spectrum of cardiovascular anomalies characterized by a functional single ventricle or nonseptatable heart. These surgical reconstructions, culminating in diversion of systemic venous return directly to the pulmonary arteries, are generally referred to as modified Fontan procedures. The earliest of these operations were technically complicated affairs with intentional implantation of valves in the venous pathways and frequent use of conduits made from various prosthetic and biologic materials. Over 30 years, the operations have evolved in a direction characterized by technical simplification of the pathways and procedures. Currently, modified Fontan procedures are really total cavopulmonary connections. The use of prosthetic materials has been minimized but not eliminated. ...... |
