Fontan Procedure
What is a Fontan Procedure?
The
Fontan Procedure is a type of surgery that is used for children
with complex congenital heart disease. This procedure is only
used for children who cannot have surgery that gives them
two pumping chambers. The procedure is designed to direct
the blood coming back from the body directly to the lungs,
without being pumped to the lungs by the heart.
Most patients will have had a bidirectional Glenn shunt prior to this procedure (connecting the superior vena cava to the pulmonary circulation).
Preparing for the procedure
Prior to cardiac surgery, the heart defect will be diagnosed with an EKG, a chest x-ray and an echocardiogram. Cardiac catheterization will be performed to measure the pressure in the blood vessels of the lungs, to look at how well the muscle of the heart squeezes and to see if any of the valves inside the heart are leaky. This information helps the medical staff prepare for the child's care after surgery. In addition, blood tests monitoring infection, clotting, and electrolytes are obtained. A blood test to determine the blood type and compatibility will be performed so blood will be available for the surgery.
During the procedure
During this procedure, the child will be placed under general anesthesia and special monitoring IVs will be put in. The chest is entered through the sternum (breastbone). The patient is connected to the heart/lung machine. Once the heart is stopped and emptied, the blood flow from the inferior vena cava (all the dark, unoxygenated blood returning from below the diaphragm) is diverted towards the pulmonary artery. This is done by either constructing a lateral tunnel within the upper receiving chamber of the heart or by placing a tube graft external to the heart chamber but accomplishing the same purpose. For some patients, a small opening (fenestration) is made to allow for a small amount of dark blood to mix with the red blood and act as a decompression pop-off. This can either stay open permanently or be closed at a later time in the cardiac catheterization laboratory. Appropriate temporary pacing wires and drains are then placed and the chest is closed. Following this procedure, the blood oxygen levels are much closer to normal but will not achieve completely normal levels. The oxygen saturation level is usually in the low 90's.
After the procedure
After surgery the child will need a number of days to recover from the anesthesia, the use of the heart-lung bypass equipment and the surgery. Initially, the child will be on a ventilator (breathing machine) and may need support from IV medicines and a temporary pacemaker. Once the breathing tube (endotracheal tube) is out, the main goals for the child's recovery are to have the child return to normal activity. Many of these children have problems with fluid collection in the space next to the lungs (called a pleural effusion). They may require tubes to drain the fluid and medicines that get rid of fluid from the body (diuretics). This can extend the hospital stay for some children.
Click here for recovery guidelines after discharge for congenital heart defect repair at the Inova Heart Center.
- Atrial Septal Defect (ASD) Repair
- Ventricular Septal Defect
- Tetralogy of Fallot Repair
- Arterial Switch for TGA
- Atrioventricular Canal Surgery
- Bidirectional Glenn
- Fontan
- Heart Valve Repair and Replacement
- Ross Procedure for AVR
- Patent Ductus Arteniosus
- Coarctation of the Aorta Repair
- Systemic to Pulmonary Shunt
- Pediatric Recovery
