Fontan procedure

The Fontan operation (developed by the French heart surgeon in Bordeaux MF François Fontan, born in 1929 ) is today (2004 ) as the most common palliative surgery for complex congenital heart disease who present with a Single Ventricle ( Einkammerherz ). First, applied above all in tricuspid atresia, there are now a number of modifications in other forms of Einkammerherzens. The original surgical technique in a step has been further developed and is now usually performed in two steps of operation. The operation method is displayed when

• The heart has only one ventricle functionally effective
• Mingle in this chamber arterial and venous blood
• The common chamber feeds both the systemic circulation and the pulmonary circulation

And has the objective of the previously parallel and common circuit ( high volume loading of the ventricle ) to transform into two separate, connected in series circuits.

• 3.1 Fontan - Björk

Operation steps

1 Glenn anastomosis

All congenital or surgically created central inflows to the lung arteries are interrupted. This is usually the transection of the pulmonary trunk (as the main stem ), the occlusion of a still existing ductus arteriosus and closure previously applied aorto - pulmonary shunts. The superior vena cava is cut and connected to the pulmonary artery ( pulmonary artery ). The proportion close to the heart is blind closed. The inferior vena cava passes her blood unchanged into the main chamber. Characterized persists cyanosis, but less than before the surgery.

2 Fontan completion = Total cavo - pulmonary anastomosis ( total cavo - pulmonary connection = TCPC )

The blood of the inferior vena cava is also passed through a plastic prosthesis ( Gore-Tex patch ) by ( intracardiac ) the right atrium (atrium ) to the pulmonary artery; Thus, it is a compound from the bottom created so that now also the blood from the inferior vena cava is directed directly into the lung vasculature. In these patch that separates the flowing venous blood from the non-functioning right atrium (which is connected by the removal of the remaining remnants of the atrial septum (septum atrial ) with the left atrium), a small hole is punched ( Fenestration ) that as an overflow outlet for the first time is used if the lungs can not absorb all the blood from the systemic circulation. This hole closes by itself or may be closed as part of a heart catheter examination when it is no longer necessary for the cardiovascular function.

In place of the intracardiac prosthesis today a extracardiac operation form is used, in which the redirection of the blood is conducted from the inferior vena cava via a sewn to the right atrium half-shell ( extracardiac shunt). The investment of the extracardiac shunts can - in contrast to the Glenn anastomosis with intracardiac shunt - done without the help of the heart -lung machine, since in this case the cavities of the heart does not have to be opened.

Postoperative condition

Arterial and venous blood flow are now separated. There is after TCPC (as opposed to Glenn anastomosis, where even arterial and venous blood from the lower body mix ) no cyanosis. By diverting the venous blood from the systemic circulation without functionally effective right ventricle into the pulmonary circulation, systemic circulation and pulmonary circulation are successively pumped directly. The pressure of the systemic circulation sufficient to pump the pulmonary circulation with. This is possible when the lung vascular resistance is not too high. Therefore, this operation is in patients which have developed pulmonary hypertension, or pulmonary vascular resistance is too high, not possible.

Variants

Fontan - Björk

In patients with a hypotonic though but functional right ventricle after Fontan - Björk operates (the so-called 3/4-Herz ). Here, a valveless connection between the right atrium and the right ventricle is created, which consists partly of the body's own tissue - that can grow. The advantage of this variant is the Fontan concomitant of the right ventricle in the circulatory system. This causes a stimulation of the right ventricle, which, though weak, still sometimes supports the blood flow to the lungs.

Long-term expectations

The children are developing well as a rule after this operation. Regular check-ups are displayed live long, as endocarditis.

This operation forms are carried out in Germany since the late 1980s, in the late 20th century, rising sharply. Can be used on long-term experience thus far not.