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Considerations for Biventricular Conversion of Fontan Circulation

  • S. Ram Kumar
    Correspondence
    Address reprint requests to S. Ram Kumar, MD, PhD, FACS, Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, 4650 Sunset Blvd, Mailstop #66, Los Angeles, California 90027.
    Affiliations
    Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, California

    Department of Pediatrics, University of Southern California, Los Angeles, California

    Heart Institute, Children's Hospital of Los Angeles, Los Angeles, California
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  • Jon Detterich
    Affiliations
    Division of Cardiology, University of Southern California, Los Angeles, California

    Department of Pediatrics, University of Southern California, Los Angeles, California

    Heart Institute, Children's Hospital of Los Angeles, Los Angeles, California
    Search for articles by this author
      Despite significant improvements in the management of Fontan circulation in patients with single ventricle physiology, long-term outcomes continue to be suboptimal. Conversion to biventricular circulation is increasingly gaining popularity, particularly in the subset of patients who are not ideal Fontan candidates. Meticulous image-guided planning, extensive preoperative discussions, and a team-based approach are required for successful execution of complex biventricular conversion. A segmental approach to the anatomy of the heart defect allows methodical planning of the technique of biventricular conversion. Ventricular size and function continue to be the Achilles heel of successful biventricular repair. Long-term studies comparing outcomes in patients converted to biventricular circulation to those in patients with Fontan physiology are required to appropriately tailor management approaches to an individual patient.

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