From the Guidelines
The Fontan procedure is a palliative surgical technique used to treat univentricular heart defects, creating a new circulatory system that connects the systemic venous return to the pulmonary arteries, bypassing the right ventricle. This procedure is mainly used in patients with congenital univentricular heart disease when a biventricular repair is not feasible 1. The Fontan procedure has undergone several modifications since its introduction in 1971, with the total cavopulmonary connection (TCPC) currently being the preferred technique, which replaces the atriopulmonary connection (APC) with an intracardiac or extracardiac conduit between the inferior vena cava and the pulmonary artery, along with a superior vena cava-to-pulmonary artery anastomosis (bidirectional Glenn) 1.
The success of the Fontan procedure depends on various factors, including the patient's overall health, specific cardiac anatomy, and the expertise of the surgical team. Strict selection criteria, such as low pulmonary vascular resistance and preserved ventricular function, are essential to achieve the best early and late results, with an operative mortality of around 5% in modern series 1. However, long-term complications, including atrial arrhythmias, ventricular dysfunction, and protein-losing enteropathy (PLE), can occur, and lifelong follow-up with a cardiologist experienced in adult congenital heart disease is recommended 1.
Key considerations for the Fontan procedure include:
- The creation of a new circulatory system that connects the systemic venous return to the pulmonary arteries, bypassing the right ventricle
- The importance of strict selection criteria to achieve the best early and late results
- The potential for long-term complications, such as atrial arrhythmias and PLE
- The need for lifelong follow-up with a cardiologist experienced in adult congenital heart disease
Overall, the Fontan procedure is a complex surgical technique that requires careful patient selection and management to achieve optimal outcomes, with a focus on minimizing morbidity, mortality, and improving quality of life 1.
From the Research
Fontaine Procedure
The Fontaine procedure is a classification system used to describe the severity of peripheral arterial occlusive disease. It is based on the clinical symptoms and signs of the disease, and it is commonly used to guide treatment decisions.
Stages of Fontaine Procedure
The Fontaine procedure categorizes peripheral arterial occlusive disease into four stages:
- Stage I: asymptomatic
- Stage II: intermittent claudication
- Stage III: rest pain
- Stage IV: gangrene or ulceration
Treatment Options
Treatment options for peripheral arterial occlusive disease vary depending on the stage and severity of the disease. They may include:
- Percutaneous transluminal angioplasty (PTA) 2
- Thrombendarteriectomy 3, 4
- Bypass grafting 3, 4
- Endovascular treatment 5
- Sympathectomy and fasciotomy 3
Diagnostic Methods
Diagnostic methods used to evaluate peripheral arterial occlusive disease include: