Fontan Operation After 3 Decades

he 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. Remark- ably, 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