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Wireless Telemetry Device Implantation in a Fontan Ovine Model for Continuous and Long-Term Hemodynamic Monitoring
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Published on: May 2, 2025

The failing Fontan: options for surgical therapy

C B Huddleston1

  • 1Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA. Huddlestonc@wush.edu

Pediatric Cardiology
|October 24, 2007
PubMed

Insights

The Fontan procedure treats single ventricle anomalies but can fail early or late. Late Fontan circulation failure may require reoperation or cardiac transplantation for improved outcomes.

Area of Science:

  • Cardiology
  • Pediatric Cardiac Surgery
  • Congenital Heart Disease

Background:

  • The Fontan procedure is a critical intervention for single ventricle anomalies.
  • Despite its success, Fontan circulation can experience acute or late failure.
  • Understanding failure modes is crucial for patient management.

Purpose of the Study:

  • To review the limitations and failure patterns of the Fontan procedure.
  • To discuss the management strategies for early and late Fontan failure.
  • To highlight the role of reoperation and cardiac transplantation.

Main Methods:

  • Literature review of Fontan procedure outcomes.
  • Analysis of factors contributing to early and late Fontan failure.
  • Discussion of clinical presentation and management options.

Main Results:

  • Early Fontan failure is linked to myocardial injury or high pulmonary vascular resistance, often with high mortality.
  • Late Fontan failure can manifest as heart failure symptoms or protein-losing enteropathy.
  • Various factors contribute to late failure, with many amenable to reoperation.

Conclusions:

  • Identifying hemodynamic factors is key for managing late Fontan failures.
  • Reoperation offers potential solutions for many late failure cases.
  • Cardiac transplantation remains a likely necessity for a significant proportion of Fontan patients.

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