Key result
Atriopulmonary Fontan connections fall out of favor due to late atrial dilation and arrhythmias.
Why the study?
Many patients with a functional univentricular heart treated with atriopulmonary connection Fontan circulation developed complications including right atrial dilation and atrial arrhythmias over time.
Supports avoidance of atriopulmonary Fontan in new patients; leaves open arrhythmia surveillance needs among historical survivors.
Many patients with a functional univentricular heart were treated in the 1970s and 1980s, using an atriopulmonary connection to create the Fontan circulation. 1 – 3 Although this procedure, in many patients, was initially successful, and provided arterial saturations of oxygen close to normal, as these patients were followed over the years, in some cases they developed significant complications. One complication of the atriopulmonary connection is progressive right atrial dilation, which leads to atrial arrhythmias, such as atrial flutter or fibrillation. 4 , 5 The combination of these two problems leads to low cardiac output, diminished quality of life, and poor categorization within the classification of the New York Heart Association. This, and other issues, has led most centres to abandon the atriopulmonary connection as a means of creating the Fontan circulation in favour of the lateral tunnel with cavopulmonary connections, 6 or the extracardiac conduit. 7
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Backer et al. (2006) conducted a review in Functional univentricular heart with failing Fontan circulation. Conversion to lateral tunnel with cavopulmonary connections or extracardiac conduit vs. Atriopulmonary connection was evaluated. Due to late complications such as right atrial dilation and arrhythmias, atriopulmonary connections for Fontan circulation have been largely abandoned in favor of alternative methods.
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