Single Ventricle and Fontan Procedures
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Fontan procedures are radical surgical reconstructions performed for children born with only one effective ventricle, or two that cannot be separated functionally. They entail the connection of the pulmonary vascular resistance downstream of the systemic vascular resistance, flow through both being delivered, in series, by the one ventricle, but at the cost of elevated systemic venous pressure (Fig. 10.1). This aims to eliminate shunting and the associated ventricular volume loading, and to achieve full pulmonary oxygenation.
KeywordsCardiovascular Magnetic Resonance Pulmonary Vascular Resistance Fontan Surgery Fontan Procedure Fontan Patient
Complications of early atrio-pulmonary Fontan procedures. The dilated right atrium (RA) upstream of an atrio-pulmonary Fontan connection causing compression of the right lower pulmonary vein (arrow), which then tends to exacerbates right atrial pressure and distension (AVI 1722 KB)
Desaturating shunts in three different patients. (a, Movie 10.4) A diastolic leak through the detachment of a patch placed across the right atrio-ventricular valve of a patient with double inlet left ventricle and an atrio-pulmonary Fontan connection. (b) Magnetic resonance contrast angiogram showing evidence of right pulmonary arterio-venous malformations (arrows) in a patient after Kawashima operation in whom hepatic venous return was flowing to the left lung, but not the right. (c, d) Subcutaneous (black arrow) and intra-thoracic (white arrows) branches of systemic venous to pulmonary venous collateral veins (AVI 319 KB)
- 17.Rathod RH, Prakash A, Powell AJ, Geva T. Myocardial fibrosis identified by cardiac magnetic resonance late gadolinium enhancement is associated with adverse ventricular mechanics and ventricular tachycardia late after Fontan operation. J Am Coll Cardiol. 2010;55(16):1721–8.PubMedCrossRefGoogle Scholar