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Fetal Circulation

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Fetal circulation is a unique system that facilitates the exchange of gases, nutrients, and waste products between the developing fetus and the mother. This intricate process takes place through a special organ called the placenta.
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The systemic and pulmonary circuits are crucial components of the circulatory system, working together to transport blood between the heart, lungs, and the rest of the body. The process begins with pulmonary circulation, where deoxygenated blood is pumped from the right ventricle to the lungs via the pulmonary trunk and arteries. Upon reaching the lungs, the blood becomes oxygenated and returns to the heart, specifically to the left atrium, via the pulmonary veins.
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Development of the Heart01:27

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The development of the human heart, a crucial organ, commences from the mesoderm on the 18th or 19th day after fertilization. This process initiates in the cardiogenic area, a group of mesodermal cells at the embryo's head end, which evolves into elongated strands known as cardiogenic cords. These cords undergo a transformation to form hollow-centered endocardial tubes.
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Blood Flow01:29

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Blood is pumped by the heart into the aorta, the largest artery in the body, and then into increasingly smaller arteries, arterioles, and capillaries. The velocity of blood flow decreases with increased cross-sectional blood vessel area. As blood returns to the heart through venules and veins, its velocity increases. The movement of blood is encouraged by smooth muscle in the vessel walls, the movement of skeletal muscle surrounding the vessels, and one-way valves that prevent backflow.
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Wireless Telemetry Device Implantation in a Fontan Ovine Model for Continuous and Long-Term Hemodynamic Monitoring
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Converting the Fontan Circulation: Challenges and Evolution.

Meletios Kanakis1, Anastasios Chatziantoniou2, Filippos-Paschalis Rorris3

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Summary

The Fontan operation for single ventricle hearts has evolved significantly. This review covers its history, current challenges, and future options like biventricular conversion for Fontan failure.

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Area of Science:

  • Cardiology
  • Pediatric Cardiac Surgery
  • Congenital Heart Disease

Background:

  • The Fontan operation is a critical palliative procedure for complex single ventricle congenital heart disease.
  • Decades of modifications aim to optimize hemodynamics and minimize long-term complications.
  • The evolution spans from atriopulmonary connections to total cavopulmonary connections.

Purpose of the Study:

  • To provide a historical overview of the Fontan operation's evolution.
  • To discuss current challenges and management strategies for Fontan patients.
  • To explore emerging options for Fontan circulation failure, including biventricular conversion.

Main Methods:

  • This is a collective review of existing literature.
  • Analysis of historical data and recent published results.
  • Discussion of evolving surgical techniques and patient management.

Main Results:

  • The Fontan operation has progressed through significant technical modifications.
  • Total cavopulmonary connection represents a major advancement.
  • Biventricular conversion is a new option challenging current management paradigms.

Conclusions:

  • Understanding the Fontan operation's history is crucial for managing patients.
  • There is ongoing debate regarding palliation versus heart transplantation for Fontan failure.
  • Biventricular correction offers a potential new avenue for failing Fontan circulations.