Fontan Completion

Excerpt

The Fontan procedure represents a cornerstone in managing complex congenital heart defects characterized by single-ventricle physiology. Originally described in 1971 by Drs Francis Fontan and Eugène Baudet for tricuspid atresia, the procedure has evolved into the total cavopulmonary connection, offering a palliative treatment option for pediatric patients with single-ventricle congenital heart disease. These conditions, estimated at 0.08 to 0.4 per 1000 live births, are addressed through a staged surgical approach that redirects systemic venous return directly to the pulmonary circulation, bypassing the heart, provided pulmonary pressures are low. This optimizes oxygenation and reduces ventricular workload.

Advances in surgical techniques and patient selection have improved outcomes, with patients living longer and with a better quality of life. However, morbidity remains significant due to the extracardiac manifestations of Fontan circulation, including challenges in functional status and systemic complications. Ongoing efforts focus on enhancing the understanding of long-term outcomes, addressing disparities, and innovating strategies to reduce complications and improve the quality of life in this growing patient population. This review explores the historical evolution, surgical techniques, patient selection criteria, and long-term management of Fontan cases, highlighting the challenges and future directions in care.