About Fontan Procedure

The Fontan procedure is a surgical operation designed to reroute oxygen-poor blood from the lower part of the body directly to the pulmonary artery, bypassing the heart. This allows the blood to flow to the lungs for oxygenation without passing through the heart chambers. The procedure typically follows an earlier surgery, known as the Glenn procedure, which redirects oxygen-poor blood from the upper body to the pulmonary artery and lungs. After the Fontan procedure, all oxygen-poor blood flows passively to the lungs for oxygenation, without the assistance of a ventricle to pump it.

Fontan Procedure Overview

The Fontan procedure is often used to treat various congenital heart defects involving a single functional ventricle or valve abnormalities. These conditions include:

• Hypoplastic left heart syndrome (the most common reason for the procedure)
• Hypoplastic right heart syndrome
• Tricuspid atresia
• Pulmonary atresia with intact ventricular septum
• Severe Ebstein’s anomaly
• Double inlet left ventricle
• Other single-ventricle heart defects

Procedure Steps

1. Preoperative Evaluation: A thorough assessment of the patient’s heart anatomy, overall health, and cardiac function is performed before the Fontan surgery. This includes imaging studies like cardiac catheterization, echocardiography, and MRI to evaluate heart structure and function.
2. Anesthesia and Incision: The surgery is performed under general anesthesia. A midline incision is made in the chest to access the heart and blood vessels involved in rerouting blood flow.
3. Atrial Septectomy (if needed): In some cases, an atrial septectomy may be performed, which involves creating an opening between the two atria (upper chambers of the heart) to allow venous blood to flow directly to the lungs.
4. Rerouting Blood Flow: The surgeon connects the superior vena cava (SVC) to the right atrium or pulmonary artery. This reroutes oxygen-poor blood from the upper body directly to the lungs for oxygenation.
5. Additional Modifications: Depending on the patient’s specific heart defect, additional adjustments may be made, such as using conduits, valves, or patches to optimize blood flow and prevent backflow into the heart.
6. Closure and Recovery: After the rerouting is complete, the incision is closed, and the patient is moved to the recovery area. Recovery involves close monitoring of vital signs, managing pain, and gradually resuming activities with the guidance of healthcare professionals.
7. Postoperative Care and Follow-up: Patients require ongoing cardiac care after the Fontan procedure. Regular follow-ups with a cardiologist are essential to monitor heart function, oxygen levels, and potential complications. Long-term care may include medications to support heart function, manage irregular heart rhythms, and prevent blood clots.