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What is the Fontan Procedure?

Fontan Procedure is a complex heart surgery designed to treat children born with single ventricle heart defects. These are congenital conditions where one of the heart’s two ventricles is underdeveloped or absent. The procedure reroutes blood flow so that oxygen-poor blood can return to the lungs for oxygenation, bypassing the underdeveloped or non-functional ventricle.

The Fontan procedure is typically performed in stages, with the first stage often completed shortly after birth, and the final stage occurring around 2–4 years of age. This surgery is a life-saving intervention that allows patients with a single ventricle heart defect to survive and thrive, but it requires lifelong monitoring and care.

Why is the Fontan Procedure Needed?

In a healthy heart, the right side pumps deoxygenated blood to the lungs, and the left side pumps oxygen-rich blood to the rest of the body. For children with a single ventricle defect, one side of the heart is unable to perform these functions properly. The Fontan procedure helps address this issue by directing blood from the lower body directly to the lungs, bypassing the heart’s malfunctioning ventricle.

The procedure is often the final surgical intervention after other surgeries, such as the Norwood procedure and Glenn procedure, which are performed in the early stages of life to improve blood flow and stabilize the child.

How Does the Fontan Procedure Work?

During the Fontan procedure, the surgeon creates a pathway that connects the inferior vena cava (the vein carrying blood from the lower half of the body) directly to the pulmonary arteries. This allows the blood to flow to the lungs without the need for the right ventricle to pump it. The procedure typically involves:

Surgical Incision:
The surgeon makes an incision in the chest to access the heart.
Redirecting Blood Flow:
The inferior vena cava is surgically connected to the pulmonary arteries, allowing oxygen-poor blood to flow directly to the lungs.
Completing the Circulatory Pathway:
Additional adjustments may be made to ensure that blood flows efficiently and that the lungs receive a sufficient supply of oxygenated blood.

Benefits of the Fontan Procedure

The Fontan procedure provides significant benefits for children with single ventricle defects:

Improved Oxygenation:
By rerouting blood flow, the procedure ensures the lungs receive sufficient blood flow for oxygenation.
Increased Life Expectancy:
The Fontan procedure can significantly increase the life expectancy of children with single ventricle defects, allowing them to lead a relatively normal life.
Better Quality of Life:
Patients often experience improved energy levels, better growth and development, and the ability to engage in normal activities post-surgery.

Risks and Complications of the Fontan Procedure

While the Fontan procedure is life-saving, it does come with risks and long-term considerations:

Heart Failure:
Some patients may experience complications due to the strain placed on the heart after the surgery.
Arrhythmias:
Abnormal heart rhythms are common in Fontan patients, requiring ongoing monitoring and treatment.
Liver Problems:
The increased blood flow to the liver can lead to long-term liver complications in some patients.
Exercise Limitations:
Some individuals may experience reduced exercise capacity due to the altered circulatory system.

Risks and Complications of the Fontan Procedure

The recovery process after the Fontan procedure can vary depending on the child’s age, overall health, and how well the heart adapts to the new circulation pattern. Common steps in recovery include:

Hospital Stay:
After surgery, patients typically remain in the hospital for several days to a week for monitoring and recovery.
Pain Management:
Pain medications are given to manage discomfort, and the child will be closely monitored for any signs of complications.
Follow-up Appointments:
Regular follow-up appointments are necessary to monitor heart function, oxygen levels, and overall health. These visits may include echocardiograms, MRIs, and other diagnostic tests.
Long-Term Care:
Children who undergo the Fontan procedure will require lifelong care to monitor heart function, check for arrhythmias, and manage any other complications. Regular cardiovascular check-ups are essential to maintaining good health.

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