Renewal of the Fontan circulation with concomitant surgical intervention for atrial arrhythmia

Background. Atrial arrhythmia remains one of the major complications in the longer term after the Fontan procedure. Methods. Conversion to total cavopulmonary connection was carried out conco mitantly with surgical intervention for atrial arrhythmia in 2 patients und ergoing the Fontan procedure by atriopulmonary connection and having contin ual atrial fibrillation or nutter in the longer term after the initial proc edure. Results. The surgical intervention restored sinus rhythm. Transient atrial fibrillation occasionally occurred after the reoperation in 1 patient in wh om duration of preoperative arrhythmic period had been 6 years, and defibri llation was needed twice. In the other 3 patients, no episodes of paroxysma l arrhythmia have been noted. Subsequent to renewal of the Fontan circulati on, cardiac index increased, with systemic venous pressure decreasing. All 4 patients are currently doing well with their functional status of New Yor k Heart Association functional class I. Conclusions. Combination of conversion to total cavopulmonary connection an d concomitant surgical intervention for atrial arrhythmia is effective, whe n used appropriately and in a timely manner in patients with atrial arrhyth mia in the longer term after the initial Fontan procedure by atriopulmonary connection. (C) 2001 by The Society of Thoracic Surgeons.