Fontan Procedure in South Africa

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.