Tricuspid atresia and univentricular heart after the Fontan procedure

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery

Background:

• The Fontan operation is a palliative procedure for complex congenital heart disease.
• Careful patient selection is critical for optimal outcomes.
• Long-term complications remain a significant concern despite improved operative risk.

Purpose of the Study:

• To review patient selection criteria for the Fontan operation.
• To discuss alternative treatment options for high-risk patients.
• To emphasize the importance of long-term follow-up and management of complications.

Main Methods:

• Review of existing literature and clinical guidelines.
• Analysis of patient selection criteria (e.g., Choussat et al.).
• Discussion of current and alternative surgical and medical management strategies.

Main Results:

• Optimal results with the Fontan operation are achieved in carefully selected patients meeting specific criteria.
• Cavopulmonary anastomoses and cardiac transplantation are viable alternatives for high-risk candidates.
• Long-term follow-up is essential for monitoring ventricular function, anastomotic sites, and managing arrhythmias and protein levels.

Conclusions:

• The Fontan operation, while improved, remains a palliative procedure.
• Rigorous patient selection and vigilant long-term management are paramount.
• Further research is needed on the impact of early intervention on long-term ventricular function.