DISRUPTION OF SUTURED PULMONARY VALVE IN FONTAN OPERATION

Two patients who had undergone a Fontan operation presented late with considerable disruption of a sutured pulmonary valve. Both patients ha d increasing ascites, decreased exercise tolerance, atrial arrhythmias , high right atrial pressure, and a large ratio of pulmonary blood flo w to systemic blood now. At operation, the main pulmonary artery was c losed either by suturing the anterior and posterior walls together imm ediately distal to the pulmonary valve or by reinforcing the resutured pulmonary valve with a polytetrafluoroethylene patch. Both patients h ad an uneventful postoperative course, with disappearance of the sympt oms and return of sinus rhythm. Although it is tempting to simply sutu re the usually thickened pulmonary valve in the Fontan operation, appr oximation of the pulmonary artery walls or patch reinforcement is nece ssary to minimize disruption.