Pulmonary Artery Reconstruction with Donor Aortic Homograft During Cardiac Transplantation in the Failed Fontan Circulation.

The advanced surgical management of patients with single ventricle physiology, in particular the hypoplastic left heart syndrome, has resulted in an increased number of patients with a Fontan circulation. In a proportion of these patients, the Fontan circulation will ultimately fail and cardiac transplantation may be required. Their course may be complicated by the hemodynamic consequences of the failing Fontan, multiple previous operations, and the frequent need for complex reconstruction at transplantation. We describe a patient with a failed modified Fontan circulation requiring concomitant pulmonary artery reconstruction and cardiac transplantation and review potential reconstruction techniques.