CV Grand Rounds - The Fontan Operation: Unanticipated Consequences

The Fontan operation is a procedure applied to patients with a single ventricle that results in venous blood from the body being directed into the lungs.  It is common for a palliative procedure (shunt or pulmonary artery band) to have been required prior to the Fontan procedure.  The procedure is typically performed at approximately 3 years of age.

In the following video, Dr. Alexander Egbe, delineates the hemodynamics of the single ventricle, reviews the basics of the Fontan operation as well as explains the unanticipated consequences of the operation. He lists the following consequences:

• Atrial arrhythmia, which in the event of a pulmonary embolism the absence of subpulmonary ventricle can have severe consequences and explains the research on DC Cardioversions as a form of acute arrhythmia management as well as other strategies, citing their effectiveness.
• Thromboembolisms, explaining their difficulty to treat, due to balancing a tendency to clot and a tendency to bleed while answering multiple questions that arise from trying to balance those risk factors.
• Lastly, liver disease due to low cardiac output while having high central venous pressure.

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