Hemodynamic evaluation of Fontan operation in tricuspid atresia.

Six patients underwent hemodynamic studies at 2 to 34 months (mean 15 months) following a modified Fontan operation. Only one patient had a valve at the inferior vena cava (IVC)-right atrium (RA) junction. Average age at surgery was 12 years (range 5-26 years). Three patients were catheterized twice. Postoperative studies showed four patients to be in sinus rhythm and two in junctional rhythm. Two patients had a RA-left pulmonary artery (LPA) gradient across the conduit of 1.5-10 mm Hg. The RA pressure was elevated an average of 17 mm Hg (10-34). All patients showed good atrial transport function regardless of their rhythm. The average arterial saturation was 92% (87%-97%), which was an improvement of 13% over preoperative values. Residual hypoxemia was due to pulmonary vein desaturation and to atrial right-to-left shunting early after surgery and to atrial right-to-left shunt alone, later. Death followed re-operation for removal of the porcine valves in the patient with two valves inserted. Macroscopically, both valves were found to have fibrous tissue ingrowth that had fixed them in a semi-open position.