Fontan procedure

(Francois Maurice Fontan, 20th century, French heart surgeon) operation to divert systemic venous blood flow into the pulmonary artery without passage through the right ventricle. The initial Fontan procedure involved an anastomosis of the right atrial appendage to the pulmonary artery. Several modifications have been devised including direct connection of the superior vena cava to the superior aspect of the right pulmonary artery and construction of a conduit from the inferior vena cava to the undersurface of the right pulmonary artery or into the main pulmonary artery. Construction of the conduit from the inferior vena cava has been done both inside and outside of the right atrium. Frequently, the operation is a staged procedure starting with a superior vena caval right pulmonary arterial connection. The operation is performed for the correction of tricuspid atresia, hypoplastic right heart, hypoplastic left heart syndrome and single ventricle. It is employed in any complex anomaly in which there is only one adequate morphological or functional ventricle.

Chest X-ray after Fontan procedure may demonstrate persistent or recurrent pleural effusions. Cardiac catheterization and pulmonary arteriography are necessary preoperatively in order to exclude pulmonary arterial hypertension and pulmonary arterial stenoses. Such impediments to pulmonary blood flow produce a poor outcome. Cardiac angiography, echocardiography and MRI are used to depict the Fontan connection and to evaluate blood flow through this circuit into the pulmonary arteries. These imaging studies demonstrate severe enlargement of the right atrium and/or inferior vena cava and stasis of blood in this structure in patients with a poor result (Fig.1).

CBH