CASE REPORT Biventricular conversion for Fontan failure Noor Amin 1 & Sudip Dutta Baruah 1 & Smita Mishra 1 & Vishal Kamlaprasad Singh 1 & Rajesh Sharma 1 Received: 26 September 2015 /Accepted: 2 May 2016 /Published online: 28 May 2016 # Indian Association of Cardiovascular-Thoracic Surgeons 2016 Abstract Certain cardiac malformations may pose difficulties in achieving a biventricular repair, and univentricular repair may be selected for them if the Fontan criteria are satisfied. However, univentricular palliation is not without its own drawbacks. We present a patient with double outlet of the right ventricle with pulmonic stenosis where the Fontan operation was conducted but where there was early Fontan failure in the short term and she needed conversion to a biventricular physiology. Keywords DORV . Fontan failure . Biventricular conversion Introduction Improved outcomes with and relative technical ease of performing univentricular repair (UVR), along with shorter intensive care unit (ICU) stay and, therefore, lesser financial burden on family and hospital are some of the reasons that can tempt a pediatric cardiac surgeon to prefer this option to a technically demanding biventricular repair (BVR). However, UVR is not without its own potential problems. These are better known to occur in the long term, the short term outcome being, usually, quite satisfactory. We present a child with double outlet of the right ventricle (DORV) with additional apical ventricular septal defects (VSD) and borderline right ventricular (RV) size with severe pulmonic stenosis (PS), who had earlier undergone a one stage extracardiac Fontan palliation elsewhere and presented to us with features of Fontan failure in the short term and who could be successfully salvaged by converting to a biventricular circulation. Case report A 14-year-old girl who had undergone an extracardiac Fontan procedure elsewhere, 3 years ago, presented with complaints of exertional dyspnea, abdominal distention, and lower limb edema. She was on high dose of diuretics and ace inhibitors. In the interim, she had had multiple readmissions for drain- age of pleural fluid and surgical pleurodesis on the right side and an interventional procedure wherein she had a stent inserted across the origin of the left pulmonary artery (LPA). Examination revealed a midline scar over the sternum and a scar of a right thoracotomy and multiple bilateral scars of previous thoracostomy tube insertions. She had jugular veins visible in the upright position and mild cyanosis. There was obvious abdominal distension with free fluid and gross hepa- tomegaly with visible superficial veins. There was no murmur audible and breath sounds were reduced over the right chest. Chest X Ray showed diffuse haziness in the right lung field with some degree of cardiomegaly. A radiopaque mesh was visible in the superior cardiac silhouette. Echocardiogram showed situs solitus with Levocardia. There was a 1-cm atrial septal defect of the secundum variety and two separate atrioventricular (AV) valves with concordant atrioven- tricular connection. Both great arteries were seen to arise from the RV which was visibly smaller than the left ventricle (LV). The tricuspid valve size was adequate (z score 0.47). There was no AV valve leak. There was severe subvalvular and annular narrowing of the pulmonary valve which was bicuspid. The main pulmonary artery was dilated but without antegrade flow into the distal pulmonary arteries. The aortic valve was trileaflet * Rajesh Sharma rsharmacvs@hotmail.com 1 Department of Pediatric Cardiac Surgery, Jaypee Hospital, Noida, India Indian J Thorac Cardiovasc Surg (2016) 32:201–204 DOI 10.1007/s12055-016-0439-0