Changing policies in selection of Fontan’s patients

The Fontan operation was introduced in 1971 as a definitive palliative procedure only for patients with tricuspid atresia, now it is performed for more complex cyanotic congenital heart disease that were not suitable for biventricular repair as well. Originally Choussat define 10 criteria for patient selection for Fontan operation which has been named 10 Choussat commandments . Due to the continuous improvement of surgical techniques with better pre and postoperative management, Fontan’s original criteria were broadened and changed basically .So even in high-risk patients who were not considered to be Fontan candidates, good early and midterm results after Fontan completion can be achieved.The strictness of criteria differs slightly between different institutions, but some of them are still prerequisites for satisfying postoperative results.This discussion would be about changes in selection criteria to give patients a chance that principles of Fontan’s operation could be applied, knowing that we still do not have long-term results.