Fontan conversion to total cavopulmonary connection and XXXX ablation: clinical and functional results.

@entity1 @entity296 @entity26 @entity591 @entity299 @entity67 @entity943 @entity204
OBJECTIVES: To assess the early results of conversion from atriopulmonary to total cavopulmonary connection in @entity1 with failing Fontan operation. DESIGN: Early clinical and instrumental evaluation of @entity1 undergoing conversion from atriopulmonary to total cavopulmonary connection from April 1999 to November 2000. SETTING: Tertiary referral centre for @entity299 . @entity1 : 11 Fontan @entity1 (mean (SD) age 20.9 (6.7) years) with refractory @entity943 or @entity67 . INTERVENTIONS: Total cavopulmonary connection, intraoperative ablation, and AAIR pacemaker implantation. MAIN OUTCOME MEASURES: Holter monitoring, transoesophageal atrial stimulation, ergometric test, and @entity296 at a mean (SD) follow up of 16.8 (5.6) months. RESULTS: One early postoperative @entity204 occurred. During follow up three @entity1 had relapse of @entity591 , controlled by medical treatment, and two were pacemaker dependent. Transoesophageal stimulation did not induce @entity591 in any @entity1 . Ergometric test showed a diminished exercise tolerance in all but one @entity1 . Mean minute ventilation and maximum @entity26 consumption were 62% and 40% of their respective predicted values. @entity296 showed reversal of rest or exercise dysfunction in five @entity1 and improved systemic ventricular function in seven. Mean basal ejection fraction increased from 39.4% (95% confidence interval (CI) 32% to 46%) to 46.5% (95% CI 41.7% to 51.2%) and ejection fraction on effort from 42.3% (95% CI 33.9% to 50.7%) to 50.2% (95% CI 44.5% to 55.9%). CONCLUSIONS: Our data show that total cavopulmonary connection associated with intraoperative ablation and pacemaker implantation allows for better control of @entity943 and improves ventricular function in the majority of @entity1 with failing Fontan.
