{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:53:59Z","timestamp":1784130839175,"version":"3.55.0"},"reference-count":21,"publisher":"BMJ","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"accepted":{"date-parts":[[2001,4,17]]},"published-print":{"date-parts":[[2001,9,1]]},"abstract":"<jats:sec>\n                  <jats:title>SETTING<\/jats:title>\n                  <jats:p>Tertiary adult congenital cardiac referral centre.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>DESIGN<\/jats:title>\n                  <jats:p>Retrospective cross sectional analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>To report our 20 year experience with adult Fontan operations, and to compare late outcome in patients with single ventricle with definitive aortopulmonary or cavopulmonary shunt palliation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PATIENTS AND MAIN OUTCOME MEASURES<\/jats:title>\n                  <jats:p>Patients older than 18 years undergoing Fontan operation between 1 January 1982 and 31 December 1998 were identified. Mortality and late outcome were derived from hospital records. These patients were compared with a cohort of 50 adults with single ventricle who had not undergone a Fontan operation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>61 adults, median age 36 years (range 18\u201347 years), with a median follow up of 10 years (range 0\u201321 years) were identified. Actuarial survival was 80% at one year, 76% at five years, 72% at 10 years, and 67% at 15 years. Compared with before the Fontan operation, more patients were in New York Heart Association (NYHA) functional class I or II at the latest follow up (80% <jats:italic>v<\/jats:italic> 58%, p\u2009&lt;\u20090.001). Systolic ventricular function deteriorated during follow up such that 34% had moderate to severe ventricular dysfunction at the latest follow up compared with 5% before Fontan (p\u2009&lt;\u20090.001). Arrhythmia increased with time (10% before Fontan <jats:italic>v<\/jats:italic> 57% after 10 years, p\u2009&lt;\u20090.001). Fontan patients had improved NYHA functional class, ventricular function, atrioventricular regurgitation, and fewer arrhythmias than the non-Fontan group at the latest follow up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSION<\/jats:title>\n                  <jats:p>The Fontan operation in adults has acceptable early and late mortality. Functional class, systolic ventricular function, atrioventricular regurgitation, and arrhythmia deteriorate late after surgery but to a lesser degree than in non-Fontan patients with a single ventricle.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heart.86.3.330","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T06:37:59Z","timestamp":1027751879000},"page":"330-335","source":"Crossref","is-referenced-by-count":71,"title":["The Fontan procedure in adults"],"prefix":"10.1136","volume":"86","author":[{"given":"G R","family":"Veldtman","sequence":"first","affiliation":[{"name":"University of Toronto Congenital Cardiac Centre for Adults, Stroke Ronald Lewar Centre of Excellence, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Nishimoto","sequence":"additional","affiliation":[{"name":"University of Toronto Congenital Cardiac Centre for Adults, Stroke Ronald Lewar Centre of Excellence, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Siu","sequence":"additional","affiliation":[{"name":"University of Toronto Congenital Cardiac Centre for Adults, Stroke Ronald Lewar Centre of Excellence, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Freeman","sequence":"additional","affiliation":[{"name":"University of Toronto Congenital Cardiac Centre for Adults, Stroke Ronald Lewar Centre of Excellence, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P M","family":"Fredriksen","sequence":"additional","affiliation":[{"name":"University of Toronto Congenital Cardiac Centre for Adults, Stroke Ronald Lewar Centre of Excellence, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M A","family":"Gatzoulis","sequence":"additional","affiliation":[{"name":"University of Toronto Congenital Cardiac Centre for Adults, Stroke Ronald Lewar Centre of Excellence, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W G","family":"Williams","sequence":"additional","affiliation":[{"name":"University of Toronto Congenital Cardiac Centre for Adults, Stroke Ronald Lewar Centre of Excellence, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G D","family":"Webb","sequence":"additional","affiliation":[{"name":"University of Toronto Congenital Cardiac Centre for Adults, Stroke Ronald Lewar Centre of Excellence, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2001,9,1]]},"reference":[{"key":"2025091923192639000_86.3.330.1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.26.3.240"},{"key":"2025091923192639000_86.3.330.2","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/S0022-5223(19)35818-0","article-title":"Extending the limits for modified Fontan procedures.","volume":"92","author":"Mayer","year":"1986","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025091923192639000_86.3.330.3","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/S0022-5223(19)35821-0","article-title":"The Fontan operation: ventricular hypertrophy, age, and date of operation as risk factors.","volume":"92","author":"Kirklin","year":"1986","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025091923192639000_86.3.330.4","first-page":"102","article-title":"Modified Fontan operation in patients less than four years of age.","volume":"86 (suppl 2)","author":"Pearl","year":"1992","journal-title":"Circulation"},{"key":"2025091923192639000_86.3.330.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(96)01256-8"},{"key":"2025091923192639000_86.3.330.6","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(88)90772-2"},{"key":"2025091923192639000_86.3.330.7","unstructured":"Ghai A, Harris L, Harrison D, et al. Outcomes of late atrial tachyarrhythmias in adults after the Fontan operation. J Am Coll Cardiol. In press."},{"key":"2025091923192639000_86.3.330.8","doi-asserted-by":"publisher","DOI":"10.1136\/heart.83.1.51"},{"key":"2025091923192639000_86.3.330.9","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.81.5.1520"},{"key":"2025091923192639000_86.3.330.10","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.85.2.469"},{"key":"2025091923192639000_86.3.330.11","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1016\/S0003-4975(00)01438-7","article-title":"Interventions associated with minimal Fontan mortality.","volume":"70","author":"Van Arsdell","year":"2000","journal-title":"Ann Thorac Surg"},{"key":"2025091923192639000_86.3.330.12","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/S0022-5223(19)35463-7","article-title":"Thirty-year follow-up of superior vena cava-pulmonary artery (Glenn) shunts.","volume":"100","author":"Kopf","year":"1990","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025091923192639000_86.3.330.13","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(84)90595-2"},{"key":"2025091923192639000_86.3.330.14","doi-asserted-by":"publisher","DOI":"10.1136\/heart.83.4.420"},{"key":"2025091923192639000_86.3.330.15","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.80.2.314"},{"key":"2025091923192639000_86.3.330.16","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1016\/0735-1097(91)90511-7","article-title":"Early and late results of the modified Fontan procedure for double-inlet left ventricle: the Mayo Clinic experience.","volume":"18","author":"Mair","year":"1991","journal-title":"J Am Coll Cardiol"},{"key":"2025091923192639000_86.3.330.17","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.68.8.199"},{"key":"2025091923192639000_86.3.330.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(97)70402-1"},{"key":"2025091923192639000_86.3.330.19","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(94)91924-0"},{"key":"2025091923192639000_86.3.330.20","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/S0022-5223(19)35562-X","article-title":"Inferior vena cava-pulmonary artery extracardiac conduit: a new form of right heart bypass.","volume":"100","author":"Marcelletti","year":"1990","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025091923192639000_86.3.330.21","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/S0022-5223(19)35174-8","article-title":"Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. 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