Fontan Circulation

Fontan Circulation Fontan repair of tricuspid atresia was initiated in late 1960s. Francis Fontan et al reported that surgical repair was carried out in three patients with tricuspid atresia of which two were successful [1]. Inferior venacaval blood was directed to the left lung and the right pulmonary artery received the superior venacaval blood through a cavopulmonary anastomosis. They mentioned that the size of the pulmonary arteries must be large enough and at sufficiently low pressure to allow flow in a cavopulmonary anastomosis. The first step was a Glenn procedure in which distal end of right pulmonary artery was anastomosed to the superior vena cava. Proximal end of the right pulmonary artery was anastomosed to the right atrium so that after closure of the atrial septal defect, inferior vena caval blood is directed to the left pulmonary artery. The main pulmonary artery was ligated at its exit from the hypoplastic right ventricle. Two aortic or pulmonary valve homografts were used to propel inferior vena caval blood to left lung. One was at the junction of inferior vena cava and right atrium to prevent back flow of blood during atrial systole. The other was at the anastomosis of right atrial appendage to the proximal end of the right pulmonary artery, to prevent reflux from left pulmonary artery to right atrium during atrial diastole [1]. Various modifications for Fontan procedure have since been introduced. Total cavopulmonary connection (TCPC) by Marc de Leval et w...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiac Surgery Source Type: blogs