Fontan procedure is a surgery carried out for the treatment of Hypoplastic Left Heart Syndrome (congenital (present by birth) abnormality in children, where children possess only a single functional ventricle). In this syndrome, the oxygen-rich and the oxygen-empty blood are mixed in the circulation, causing the child to turn blue. Fontan procedure is the third stage of repair after two other operations and is carried out when a child is between 18 months and 2 years of age. The aim of this procedure is to separate the red blood (oxygen filled) from the blue blood (oxygen-empty). This is a surgery done to decompensate the pressure in the ventricle.
With tremendous medical advancement in Indian hospitals, many disease conditions are being diagnosed and treated accurately and timely. The surgery set up in India is quite good and many hospitals in North and South India have started performing Fontan surgery due to technical advancements in the medical set up. Pediatric cases from all over India and even some parts of the world are being referred to Indian hospitals, and if the cardiologists find the patients fit, Fontan surgery is carried out. With highly experienced cardiologists, cardiothoracic surgeons and nursing staff, Fontan surgery in India are gaining popularity in the medical tourism world.
Low cost of Fontan procedure as compared to abroad and availability of all the diagnostic and therapeutic facilities are few of the many advantages of a Fontan procedure in India. The low cost of Fontan surgery allows people from all over the world, especially in underdeveloped countries, to have an access to first class medical treatment. The type of Fontan hospital where the patient is treated in, treatment method, type of anesthesia or sedation, other treatments performed along with Fontan surgery and the choice of the city are major factors which determine the cost of a Fontan procedure in India.
The Fontan procedure is performed in children with a special type of congenital disorders that leaves them with a single functioning ventricle. There are two ventricles in the heart, one supplies blood to the lungs while the other pumps blood to the rest of the body parts.
Some children may be born with just one functional ventricle because of an absence of a heart valve or an abnormality in the ability of the ventricles to pump blood. As a result, a single ventricle has to work hard to supply blood to the lungs and the rest of the body at the same time. In such children, the Fontan procedure is performed.
The Fontan procedure is usually conducted when the child is between the age two and five. However, it can be conducted before two years of age. The Fontan procedure is contraindicated in children with high pulmonary vascular resistance. This is because as a part of this procedure, the blood must flow through the lungs without the pumping function of the heart. The Fontan procedure is also contraindicated in children with mitral insufficiency, left ventricular dysfunction, and pulmonary artery hypoplasia. The Fontan operation is also conducted in adults with this defect. The treatment is more complicated in such patients, as adults are more likely to develop Protein-Losing Enteropathy (PLE). It is a condition in which the protein is lost through the gut and it may lead to internal bleeding and fluid retention. But the complications resolve on its own when the surgery is performed. Such patients may sometimes even need a heart transplant.
The Fontan procedure is performed under the influence of general anesthesia. The patient is shifted to the surgical room an hour before the actual time of the surgery. General anesthesia is administered and once the patient is in deep sleep, a tube is inserted into the windpipe.
The body of the patient is connected to machines so that his or her vital parameters can be observed throughout the surgery and after that.The main purpose of the surgery is to optimize the Fontan circulation so that a single ventricle is able to effectively pump pure blood to the entire body and the impure blood to the lungs without any pumping mechanism. During the surgery, the surgeon opens the thoracic cavity by cutting through the sternum, which is a bone attached to the ribs. Doing so provides direct access to the heart.
Next, the surgeon uses either the extra-cardiac method or the lateral tunnel method to make the impure blood reach the lungs. The create a hole between the Fontan circuit and the right atrium to relieve the pressure. The hole, also known as “fenestration,” closes of its own later or can be closed off later with the help of cardiac catheterization.
The patient is transferred to the recovery room after the surgery and this is where all his or her vital signs are monitored for a couple of hours. Once the patient is stable, he or she is transferred to the cardiac ward.
The doctors may administer painkillers to control pain after the surgery. Expect the patient to be kept in the hospital for a few days. Additionally, eating and drinking are restricted for a few days after the surgery. Once the bowel movement resumes normally, the patient is given a light diet and fluids. This may take anywhere from two to three days. The medications and fluids are administered through an IV line until the patient starts taking normal diet. The dressing is changed every day during the hospital stay. A majority of patients are able to return to their normal routine within the first three months of the surgery. They are advised to increase their activities gradually and not to exert themselves too much.
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