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The hemi-Fontan operation
Marshall L Jacobs1, Kamal K Pourmoghadam
1Section of Cardiothoracic Surgery, St Christopher's Hospital for Children, Philadelphia, PA 19134, USA.
Insights
The hemi-Fontan operation reduces volume load on single ventricle hearts, preparing them for a modified Fontan procedure. This surgical approach involves connecting the superior vena cava to pulmonary arteries and other preparatory steps.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Hearts with a functional single ventricle experience increased cavity volume and muscle mass due to excessive volume load from parallel circulations.
- The hemi-Fontan operation is designed to mitigate this volume work in preparation for a complete Fontan procedure.
Purpose of the Study:
- To describe the hemi-Fontan procedure as a preparatory surgical step for single ventricle physiology.
- To outline the key components and potential concomitant procedures associated with the hemi-Fontan operation.
Main Methods:
- Association of the superior vena cava (SVC) with branch pulmonary arteries.
- Augmentation of central pulmonary arteries and occlusion of SVC inflow into the right atrium.
- Elimination of alternative pulmonary blood flow sources.
Main Results:
- The hemi-Fontan procedure effectively reduces volume work on the single ventricle.
- It serves as a crucial preparatory stage for a subsequent modified Fontan procedure.
Conclusions:
- The hemi-Fontan operation is a valuable strategy for managing single ventricle physiology.
- Concomitant procedures can be efficiently performed during the hemi-Fontan to address associated cardiac anomalies.
Abstract:
In hearts with a functional single ventricle, cavity volume and myocardial muscle mass increase as a consequence of the excessive volume load associated with parallel pulmonary and systemic circulations. The hemi-Fontan operation was conceived as a means of accomplishing early reduction of the volume work of the single ventricle, in anticipation of eventual completion of a modified Fontan procedure. The hemi-Fontan procedure includes association of the superior vena(e) cava(e) (SVC) with the branch pulmonary arteries, augmentation of the central pulmonary arteries, occlusion of the inflow of the SVC into the right atrium, and elimination of other sources of pulmonary blood flow. Because it is preparatory to an eventual completion Fontan procedure, concomitant procedures are conveniently performed in conjunction with the hemi-Fontan. These may include atrial septectomy, relief of aortic arch obstruction, proximal main pulmonary artery to ascending aortic anastomosis, repair or revision of anomalous pulmonary venous connection, atrioventricular valvuloplasty, or other procedures.
