Fontan procedure

From Wikipedia, the free encyclopedia

This article or section is in need of attention from an expert on the subject.
Please help recruit one or improve this article yourself. See the talk page for details.
Please consider using {{Expert-subject}} to associate this request with a WikiProject

The Fontan procedure is a palliative surgical procedure used in children with complex congenital heart defects. It involves diverting the venous blood from the right atrium to the pulmonary arteries without passing through the morphologic right ventricle. It was initially described in 1971 as a surgical treatment for congenital tricuspid atresia. ^[1] The Fontan procedure is nowadays used where a child only has a single effective ventricle, due to either defects of the heart valves (e.g. tricuspid atresia or pulmonary atresia) or an abnormality of the pumping ability of the heart (e.g. hypoplastic left heart syndrome). The operation itself is carried out as part of a range of operations for heart defects in children where a child cannot have bi-ventricular repair.

1 Pathology
2 Post-operative complications
3 Types of procedure
4 References

[edit] Pathology

1) PDA present- patent ductus ateriosus - a natural connection between the aorta and the pulmonary artery present prior to birth - Serves to divert blood from a fetus' lungs before birth, as placenta provides all necessary oxygen. It closes within hours/days after birth normally, unless medicines are given such as in PA where PDA helps sustain a baby's life. However, even the medication prescribed to keep open a PDA can only do so for several days at most as the body automatically closes it after several days, and thus, this only serves as a temporary "fix" until surgery could be performed.

2) VSD present- Ventricular Septal Defect- "hole" in the septum (wall that separates left and right ventricles) allows the mixing of oxygenated, and deoxygenated blood. This allows mixed blood to be pumped through the left ventricle, and the baby is kept alive.

[edit] Post-operative complications

However, the Fontan procedure is palliative, not curative. Mortality after surgery is associated with development of congestive heart failure and atrial arrhythmias. Post procedure, the incidence of atrial fibrillation and atrial flutter are increased.

[edit] Types of procedure

Currently, two forms of the Fontan procedure are performed:

an intracardiac right atrial baffle, directing blood from the inferior vena cava to the pulmonary arteries, or
an extracardiac conduit, taking blood from the inferior vena cava directly to the pulmonary arteries.

The Fontan procedure is the final of two or three palliative stages to divert systemic venous blood to the pulmonary arteries.