Pulmonary artery size and clinical outcome after the modified Fontan operation

Christopher J. Knott-Craig, Paul R. Julsrud, Hartzell V. Schaff, Francisco J. Puga, Gordon K. Danielson

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


The maximum cross-sectional area of the central pulmonary arteries indexed to the body surface area (pulmonary artery index [PAI]) was measured preoperatively from angiograms in 173 patients evaluated for a Fontan-type operation between 1981 and June 1989. Of these, 34 patients underwent another palliative procedure, 8 primarily on the basis of small pulmonary arteries (PAI, 106 to 167 mm2/m2). The mean PAI of this group was significantly smaller than the mean PAI of the remaining 139 patients who underwent a Fontan operation (136 ± 20 versus 310 ± 113 mm2/m2) (p < 0.001). The patients who underwent a Fontan operation were evaluated according to three overlapping end points: (1) hospital death or takedown of repair (12.2%), (2) early failure (cumulative death or takedown of repair within 6 months of operation) (16.5%), and (3) early failure or persistent effusions (33.8%). With regard to these end points, no significant difference in pulmonary artery size could be found between patients having a favorable or unfavorable outcome. However, among a low-risk subset of 30 patients with tricuspid atresia, those with "early failure or persistent effusions" had significantly smaller pulmonary arteries than those with a good outcome (PAI, 185 ±47 versus 276 ± 83 mm2/m2) (p < 0.01). The postoperative transpulmonary gradient of the 8 patients with the smallest pulmonary arteries who underwent a Fontan operation (all PAIs < 170 mm2/m2) was significantly greater than that of the rest of the study group (9.88 ± 2.3 versus 8.13 ± 2.3 mm Hg) (p < 0.04). Small pulmonary arteries, in otherwise good-risk patients, are associated with increased risk of "early failure or persistent effusions" after the Fontan operation. The lowest PAI compatible with success remains unknown. To obtain a more comprehensive assessment of a successful outcome, we suggest that evaluation of patients after a Fontan operation include end points other than hospital death.

Original languageEnglish (US)
Pages (from-to)646-651
Number of pages6
JournalThe Annals of thoracic surgery
Issue number3
StatePublished - Mar 1993

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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