Fontan operation for complex cyanotic heart disease

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Abstract
The Fontan operation and its modifications are the appropriate surgical treatment for many forms of complex congenital heart disease. Current literature reviewed for this article advocates use of the Fontan operation in younger patients. There is concern about defining and evaluating the selection process of patients for the Fontan operation in attempting to determine which patients are most likely to survive. Articles on this subject are also part of this review. For certain high-risk patients, a bidirectional caval-pulmonary anastomosis has been advocated, and those reports are reviewed. The perioperative and postoperative assessment of patients after the Fontan operation—including arrhythmias and electrophysiologic findings—have continued to be of interest, and this literature has been reviewed. Other postoperative studies reviewed include magnetic resonance imaging results, exercise response, and effect of menstrual patterns in women. Although the Fontan operation is now widely used, the selection process and postoperative management is still evolving. The articles in this review are not the last needed to fully understand all the ramifications of this innovative operation.

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