Year : 2008  |  Volume : 1  |  Issue : 2  |  Page : 83--92

The Fontan pathway: What«SQ»s down the road?


Sachin Khambadkone 
 Great Ormond Street Hospital and Institute of Child Health, London, United Kingdom

Correspondence Address:
Sachin Khambadkone
Cardiac Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH
United Kingdom

The Fontan circulation results from routing of the systemic venous blood to the pulmonary circulation without a hydraulic source of a ventricle. Although a hypertrophied right atrium was thought to be essential for this circulation, the current form of the operation has neither the right atrium nor any valves in the venous circulation that is connected to the pulmonary arteries directly. Modifications in the operative model was one of the early steps in improving outcome. Use of fenestration, staging of Fontan completion and better perioperative management have led to a significant drop in mortality rates in the current era. Despite this, there is late attrition of patients with complications such as arrhythmias, ventricular dysfunction, and unusual clinical syndromes of protein-losing enteropathy (PLE) and plastic bronchitis. Management of failing Fontan includes a detailed hemodynamic and imaging assessment to treat any correctable lesions such as obstruction within the Fontan circuit, early control of arrhythmia and maintenance of sinus rhythm, symptomatic treatment for PLE and plastic bronchitis, manipulation of systemic and pulmonary vascular resistance, and Fontan conversion of less favorable atriopulmonary connection to extra-cardiac total cavopulmonary connection with arrythmia surgery. Cardiac transplantation remains the only successful definitive palliation in the failing Fontan patients.


How to cite this article:
Khambadkone S. The Fontan pathway: What's down the road?.Ann Pediatr Card 2008;1:83-92


How to cite this URL:
Khambadkone S. The Fontan pathway: What's down the road?. Ann Pediatr Card [serial online] 2008 [cited 2019 Nov 21 ];1:83-92
Available from: http://www.annalspc.com/article.asp?issn=0974-2069;year=2008;volume=1;issue=2;spage=83;epage=92;aulast=Khambadkone;type=0