Fontan conversion with hepatic vein exclusion: a means for hepatic preservation in single ventricle heart disease

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Gastroenterology

Background:

• Single ventricle heart disease necessitates staged surgical palliation, leading to Fontan anatomy.
• Long-term Fontan physiology is associated with severe complications like liver cirrhosis and protein-losing enteropathy.
• Elevated central venous pressure and visceral venous congestion are implicated in these adverse outcomes.

Observation:

• A novel surgical technique is presented to address the complications of Fontan anatomy.
• This operation aims to protect the liver and intestines by excluding splanchnic venous return from the Fontan pathway.
• The modification exposes abdominal viscera to lower common atrial pressures instead of elevated Fontan pressures.

Findings:

• The presented surgical modification aims to mitigate the long-term abdominal complications associated with Fontan physiology.
• By altering venous return, the procedure seeks to reduce hepatic and intestinal exposure to high pressures.
• This approach holds potential for improving patient outcomes and reducing morbidity.

Implications:

• This novel surgical strategy may offer a method to prevent or reduce the incidence of cirrhosis and protein-losing enteropathy in Fontan patients.
• The modification could lead to improved quality of life and survival rates for individuals with single ventricle heart disease.
• Further clinical investigation is warranted to validate the long-term efficacy and safety of this innovative surgical approach.