Cardiology

Fontan surgery

Description

Fontan is a pediatric surgery to fix the abnormalities in a baby’s or a child’s heart.The procedure is performed on children who only have a single functioning ventricle due to abnormalities in pumping ability of the heart, lack of heart valve such as mitral atresia or tricuspid, or any kind of congenital heart disease, which leads to the only working ventricle to perform the pumping of blood in and out from the body and the lungs. Fontan surgery connects the vein and repair the blood circulation where the heart will only use one ventricle to flow the oxygen rich blood into the body while the oxygen poor blood does not come back to the heart and passes to the lungs. Fontan surgery is usually performed when the child is 2-5 years of age, however, in some cases, it can also be performed below 2 years of age.

The heart contains two separate ventricles, which has different jobs to do. However, when one of the ventricles is damaged, the only functional ventricle pumps blood to the body, which can create serious complications. In order to make sure the single ventricle becomes capable of doing the hard job, doctors need to configure the circulation for maximum efficiency. However, the line of treatment depends on the stage of the condition and the amount of blood flow in the lungs.

  • In some cases, the blood flow into the lungs is not enough and that can cause cyanosis. To fix this , a procedure called systemic to pulmonary artery shunt or Blalock-Taussig (BT) shunt is performed where a tube graft is positioned from the left artery to the pulmonary artery that increases the blood circulation.
  • While in cases where there is an excessive blood flow in the lungs, the pressure on the single functional ventricle increases that causes intense pressure on pulmonary arteries. In order to restrict the increased blood flow, a band is placed around the pulmonary artery.
  • Another procedure known as bi-directional Glenn is performed to fix this issue when advanced. The procedure involves cutting off the supply of the large vessel that flows the blood from head to the heart and connected directly to the pulmonary artery to ease pressure from the single ventricle. It increases the oxygen saturation level to 85%.
  • Fontan surgery is also performed where reconstruction of the single ventricle is done where blood supply to the heart from lower body is cut off and sewed to the pulmonary artery. The procedure can be performed by two different methods – lateral tunnel and extra cardiac technique, both involve making a hole between the fontan circuit and the right atrium so that if the pressure is too high on the circuit, the oxygen poor blood can escape through the hole.

Complications

Fontan surgery also contains some short term and long term complications, which are as follows:

  • Heart failure
  • Fluid building up around the lungs
  • Hypoxia
  • Hepatic fibrosis
  • Infection
  • Bleeding
  • Heavy breathing
  • Improper functioning of single ventricle

Post operative care

After the operation, the child will be taken into the recovery room where he/she will be deeply monitored. The child may need to stay at the hospital for a couple of weeks.

Once discharge, the child will require to have a blood tests within a week or two and regular medications need to be given as prescribed. The medications will be eased once the child becomes normal.

The child can take part in moderate activities gradually but must not overdo it.

You can admit your child in cardio type exercise sessions such as swimming, dancing, jogging, etc. to help him/her to increase the efficiency of their heart.

A healthy and balanced diet is extremely necessary for a good recovery.

Visit every regular appointment with the doctor to avoid any complications.