Fontan procedure

The Fontan procedure is a repair surgical strategy for congenital cardiac anomalies. It is not usually used in isolation, but in combination with other repair procedures in a staged manner in an attempt to correct the underlying cardiac pathology.

The procedure attempts to bypass the right heart. Systemic circulation is redirected into the pulmonary arteries.

It can be used in multiple situations, including:

The original procedure involved:

To improve flow dynamics, a "lateral tunnel" was introduced. The patient essentially received a bidirectional Glenn procedure:

  • the superior vena cava (SVC) is divided
  • the proximal and distal ends are anastomosed to the right pulmonary artery
  • an atrial "baffle" is put in the right atrium to direct blood toward the right pulmonary anastomosis and away from the tricuspid valve

Currently, an extracardiac conduit directs blood flow from the inferior vena cava (IVC) at the inferior cavoatrial junction to the right pulmonary artery, bypassing the right atrium. Systemic flow from the SVC is directed into the right pulmonary artery with a Glenn procedure.

Although a palliative procedure, patients treated with the Fontan procedure can reach adulthood. The maximum duration of the procedure is not well-defined.

A patient with a failing Fontan repair can receive an extracardiac Fontan conduit, if they do not already have one. The definitive procedure is cardiac transplantation.

Intracardiac and central venous thromboses are major causes of morbidity and mortality in patients after Fontan procedure. It can occur in 1%-33% of patients who underwent the procedure 4

The procedure was originally suggested in 1971 by F Fontan and E Baudet as a correction for tricuspid atresia.

Congenital heart disease

There is more than one way to present the variety of congenital heart diseases. Whichever way they are categorised, it is helpful to have a working understanding of normal and fetal circulation, as well as an understanding of the segmental approach to imaging in congenital heart disease.

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Article information

rID: 34487
System: Cardiac, Vascular
Synonyms or Alternate Spellings:
  • Fontan/Kreutzer procedure
  • Total cavopulmonary connection
  • Total cavopulmonary connection (TCPC)

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