ABC | Volume 112, Nº2, February 2019

Original Article Fernandes et al Conversion to total cavopulmonary connection Arq Bras Cardiol. 2019; 112(2):130-135 Figure 1 – Survival curve of patients submitted to FK conversion to TCPC. 1.0 0.8 0.6 0.4 0.2 0.0 0 5 10 15 20 25 Survival (%) Followup time (years) Years Patient at risk 0 9 8 8 7 6 5 3 4 4 2 1 0 4.5 2.5 0.1 5.5 13 15 22 Table 2 – Clinical improvements after conversion to TCPC Variables Before convertion (n = 10) After convertion (n = 8) Middly disfuction 2 (20%) 1 (12.5%) Moderate disfunction 3 (30%) 0 (0%) Arrhythmias 9 (90%) 4 (44%) NYHA Functional class I 3 (30%) 6 (75%) NYHA Functional class II 4 (40%) 1 (12.5%) NYHA Functional class III 3 (30%) 1 (12.5%) TCPC: total cavo-pulmonary connection; NYHA: New York Heart Association. seizures, one presented ventricular dysfunction and one presented bradyarrhythmia. Currently, eight patients are undergoing an outpatient clinic and one patient is being evaluated for heart transplantation. Discussion Fontan-Kreutzer conversion to TCPC is not a simple procedure. Despite a small sample size, we observed a 20% mortality in our experience. The prolonged hospitalization time, average of 37 days, also demonstrates the problems in the management of these patients in the postoperative period. In 25% of the patients evaluated, some types of complications were observed in the postoperative period, where most of them were resolved clinically without the need for new surgical procedures. These facts indicate that ideally this type of surgery should be performed in specialized tertiary centers with the availability of a multidisciplinary team for the best care of the patients. Caneo et al. 2 showed a total mortality of 11% for all FO conducted in our Institution, the majority of the death cases were observed in the first period of the study (between years 1984-1994). All atriopulmonary Fontan were performed in the first and second periods (between years 1984‑2004), 23,9% of them was elected for conversion years after, and all of these Fontan procedures were performed in the first period. A similar finding was observed in our study, where mortality occurred in the beginning of the experience by the years 1996 and 2000, our first two cases of conversion. It is possible that these two cases have evolved to an unfavorable outcome due to the unavailability of technological resources presented at that time. Atrial arrhythmias were the main indications of conversion because the modifications performed by Kreutzer resulted in large atrial dilations generating many disorders of the atrial rhythm, which complicated ventricular dysfunction and worsened symptomatology. We obtained an unsatisfactory 132