Ventricular Exclusion during Fontan Operation: An Evolving Technique

Abstract The modified Fontan operation, which consists of ventricular exclusion by obliteration of the right atrioventricular ostium, requires a technique that provides firm and permanent occlusion while preserving the atrioventricular node and bundle. Ten patients underwent such an operation. In 5 of them, closure of the right atrioventricular ostium was achieved by suturing a patch into the valve leaflets; in the other 5, the ventricle was excluded by a patch sutured into the right atrial wall above the annulus fibrosus. None of the patients who underwent this procedure experienced heart block postoperatively. However, three instances of late patch dehiscence occurred, each in the group of patients in whom the patch had been attached to the valve leaflets. We conclude that both patching techniques are safe as far as the atrioventricular node and bundle are concerned but that permanent occlusion is better obtained by implanting the patch into the atrial wall. Therefore, we prefer to use this technique.