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The Fontan circulation: a challenge to William Harvey?
1Great Ormond Street Hospital for Children NHS Trust, London, UK. DeLevM@gosh.nhs.uk
Nature Clinical Practice. Cardiovascular Medicine
|November 3, 2005
Summary
The Fontan operation offers a life-saving treatment for single ventricle heart defects. Despite surgical improvements, long-term Fontan circulation may still lead to reduced function and early death.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Physiology
Background:
- The Fontan operation is the standard surgical palliation for single ventricle congenital heart disease.
- This procedure connects systemic and pulmonary circulations in series, relying on a single ventricle.
- Developed over 35 years ago, it has significantly improved outcomes for many children.
Purpose of the Study:
- To review the long-term implications and potential adverse effects of the Fontan operation.
- To address concerns regarding continuing attrition despite surgical advancements.
Main Methods:
- Review of historical experimental and clinical research.
- Analysis of outcomes following the Fontan operation over several decades.
- Evaluation of surgical procedure refinements and their impact.
Main Results:
- The Fontan operation has benefited a large number of patients with single ventricle physiology.
- Despite surgical refinements, there is ongoing concern about long-term attrition.
- Adverse effects include decline in functional capacity and premature late mortality.
Conclusions:
- The Fontan operation remains a critical intervention for single ventricle defects.
- Long-term surveillance is essential to manage potential complications.
- Further research may be needed to mitigate late adverse effects and improve long-term survival.