Overview:
The Fontan procedure is a surgical procedure for the heart. This surgery is undertaken when a child is born with only one functioning ventricle. This procedure improves the circulation of the heart. One ventricle fails in some children as a result of congenital heart issues. This surgery helps move deoxygenated blood (lower in oxygen) from the lower body straight to the pulmonary artery. This procedure bypasses the heart.
After this procedure, all the blood from the lower body moves directly to the pulmonary artery without moving into the ventricles. This helps the heart ease the pumping as the ventricle is malfunctioning.
What Is the Ventricle of the Heart and Its Function?
The human heart comprises four chambers, two atriums (upper chambers of the heart), and two ventricles (lower chambers). The atrium and ventricle function together to circulate blood all around the body. One ventricle takes deoxygenated blood from the two ventricles to the pulmonary artery. The other ventricle pumps oxygen-rich blood all over the body.
When Is the Fontan Procedure Indicated?
The Fontan procedure is mainly indicated in children with only one functioning ventricle. It is mostly undertaken by children between the ages of two to fifteen. However, the ideal age is three to five years. However, this procedure is not indicated for all children with defective ventricles. The pediatric surgeon determines the need for this procedure.
When Fontan is performed, the blood flow is entirely diverted from the heart to the pulmonary artery. This makes the heart's single ventricle function.
What Are Congenital Heart Defects?
Developed in the late 1960s by Dr. Guillermo Fontan and Dr. Eugene Kreutzer, the Fontan procedure was initially considered an experimental approach. However, it has evolved into a critical intervention for children with single ventricle heart defects over the decades. The procedure's primary goal is to directly divert venous blood from the body to the pulmonary arteries, bypassing the missing ventricle.
The Fontan procedure is typically performed in stages, often involving a series of surgeries over several years. In its completion, it creates a unique circulation where oxygen-poor blood from the body bypasses the heart's missing ventricle. It is directed straight to the lungs, ensuring oxygenation before being pumped back into the body.
What Are the Uses of the Fontan Procedure?
The following are the uses of this procedure:
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Hypoplastic Heart Syndrome: Hypoplastic heart syndrome is a condition in which the left or right side of the heart is severely underdeveloped. It is a congenital defect of the heart.
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Tricuspid or Pulmonary Atresia: Atresia is a condition in which the blood vessels of the heart are improperly formed. There is no definite cause for this occurrence, but it is believed that it is a congenital defect.
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Congenital Transposition Arteries: This is a congenital heart condition known as congenital transposition of the greater arteries. In this condition, the two main arteries that leave the heart are placed next to each other.
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Ebstein’s Anomaly: This is also a congenital condition of the heart wherein the tricuspid valve is placed slightly lower than usual.
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Double Inlet Left Ventricle: Again, this is a congenital condition in which the left ventricle is affected. In this condition, the left ventricle fails to pump.
How Is the Fontan Procedure Useful for Single Ventricle Heart Defects?
Developed in the late 1960s by Dr. Guillermo Fontan and Dr. Eugene Kreutzer, the Fontan procedure was initially considered an experimental approach. However, it has evolved into a critical intervention for children with single ventricle heart defects over the decades. The procedure's primary goal is to directly divert venous blood from the body to the pulmonary arteries, bypassing the missing ventricle.
The Fontan procedure is typically performed in stages, often involving a series of surgeries over several years. In its completion, it creates a unique circulation where oxygen-poor blood from the body bypasses the heart's missing ventricle. It is directed straight to the lungs, ensuring oxygenation before being pumped back into the body.
What Happens Before This Procedure?
Before this procedure, the doctor may perform certain tests to evaluate the patient's condition. The various diagnostic tests that may be performed include:
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Imaging Tests: Various imaging techniques such as CT (Computed tomography), and MRI (Magnetic resonance Imaging). These tests help in assessing the chambers and the pumping of the heart.
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Transthoracic Echocardiography (TTE): It is a specific heart diagnostic. It is also known as the ultrasound of the heart. This test helps to evaluate the blood flow in the heart in a non-invasive way. At times, even contrast can be used to view the heart better.
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Cardiac Catheterization: This is a procedure that is used to check the electrical activity of the heart. A tube is inserted into the heart through the blood vessels to perform this diagnostic test.
What Are the Benefits of This Procedure?
The Fontan procedure brings about a multitude of benefits for individuals with single ventricle hearts:
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Improved Oxygenation: By rerouting venous blood directly to the lungs, the procedure enhances oxygenation of the blood, alleviating cyanosis (bluish skin discoloration due to low oxygen levels) and improving overall well-being.
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Enhanced Exercise Tolerance: While individuals who undergo the Fontan procedure might still experience some limitations, they often exhibit increased exercise tolerance compared to their pre-surgical state.
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Reduced Heart Workload: By allowing the remaining ventricle to handle oxygenated blood only, the Fontan procedure reduces the workload on the heart and minimizes the risk of heart failure.
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Extended Lifespan: The procedure has significantly extended the lifespan of individuals with single ventricle hearts, allowing them to reach adulthood and beyond.
What Are the Challenges and Complications of This Procedure?
While the Fontan procedure has transformed lives, it is challenging. Due to altered circulation, some individuals may experience long-term complications, such as arrhythmias, liver issues, and fluid retention. Additionally, the procedure is unsuitable for every single ventricle heart defect and must be carefully evaluated on a case-by-case basis.
Conclusion:
The Fontan procedure is a testament to medical innovation's power to transform lives. It has provided a lifeline to countless individuals born with complex single ventricle heart defects, enabling them to lead lives that were once deemed impossible. As medical knowledge and technology continue to advance, the Fontan procedure stands as a beacon of hope for families and patients facing intricate congenital heart challenges, reminding us of the remarkable potential of science and human resilience.
