INTRODUCTION
Fontan Procedure (FP) had been a hope for many patients with congenital heart diseases (CHD) when Dr. Francis Fontan (July 2nd, 1929 – January 14th, 2018) reported this technique for the first time in 1971 [1]. In this original report, the FP was carried out in three patients with the diagnosis of tricuspid atresia (TA). The right side of the heart was bypassed with the combination of a classical cavopulmonary anastomosis between the superior vena cavae and right pulmonary artery and channeling the inferior venae cavae to left pulmonary artery with interposing a homograft [2]. In his original paper, Dr. Fontan emphasized the importance of well-developed pulmonary arteries with a low pressure for the success of this operation.
In the following decades, the technique was further developed and modified and on the other hand, the indications were hugely extended to a variety of CHD with various morphologies. Probably the most important evolutions in FP were the total cavopulmonary connection either with a lateral tunnel or an extracardiac conduit and the idea of fenestration [3-5]. In the current era of cardiac surgery, the potential candidates for a Fontan procedure include a variety of CHD with one well-developed ventricle or not [6].
Early after describing FP, Dr. Fontan and his colleague Dr. Choussat reported the criteria for an ‘ideal’ Fontan candidate (table-1) [7]. These guidelines, or namely ‘the 10 commandments’ were revised and modified during the following decades, since all the criteria were not necessarily portending excellent long-term survival when statistical analysis were concerned [8,9]. Today, mean pulmonary artery pressure (MPAP) and ventricular function are probably the most prevailing criteria for selecting a patient before constituting a Fontan circulation.
Herein, we aimed to present our experience in 16 patients with a MPAP over 15 mmHg who underwent Fontan operation. We also discussed some aspects of mandatory criteria for a satisfactory outcome after FP with regard to the data reported in literature.