Fontan procedure

Fontan or Fontan Kreutzer procedure
Intervention
ICD-9-CM	35.94
MeSH	D018729
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The "Fontan procedure" or "Fontan Kreutzer procedure" is a palliative surgical procedure used in children with univentricular hearts. It involves diverting the venous blood from the IVC and SVC to the pulmonary arteries without passing through the morphologic right ventricle; i.e., the systemic and pulmonary circulations are placed in series with the functional single ventricle. It was initially described in 1971 by Dr. Francois Marie Fontan (1929 – ) from Bordeaux, France and by Dr. Guillermo Kreutzer from Buenos Aires, Argentina (1934 – ) separately as a surgical treatment for tricuspid atresia.

The Fontan procedure is used in pediatric patients who possess only a single functional ventricle, either due to lack of a heart valve (e.g. tricuspid or mitral atresia), an abnormality of the pumping ability of the heart (e.g. hypoplastic left heart syndrome or hypoplastic right heart syndrome), or a complex congenital heart disease where a bi-ventricular repair is impossible or inadvisable. The single ventricle is doing nearly twice the expected amount of work because it has to pump blood for the body and lungs. Patients typically present as neonates with cyanosis or congestive heart failure. Fontan completion is usually carried out when the patient is 2–5 years of age, but is also performed before 2 years of age.

After Fontan completion, blood must flow through the lungs without being pumped by the heart. Therefore, children with high pulmonary vascular resistance may not tolerate a Fontan procedure. Often, cardiac catheterization is performed to check the resistance before proceeding with the surgery. This is also the reason a Fontan procedure cannot be done immediately after birth; the pulmonary vascular resistance is high in utero and takes months to drop.

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