Fontan Procedure: A Case Study

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In 1971 Dr. Fontan and Dr. Baudet [26] did the first total cavopulmonary connection ‘‘Fontan Procedure’’ which is the final palliative stage for single ventricle patients. Since then, multiple techniques and modifications were invented. However, the ultimate goal of all different procedures is to achieve near complete separation of pulmonary venous return from systemic venous return. As such, all systemic venous circulation will be directed to the Fontan circulation (except the coronary sinus which continues to drain into the right atrium and when the Fontan is circuit is fenestrated) bypassing the heart [31].
Many investigators believe that routine pre-Fontan cardiac catheterization is mandatory step to assess the single ventricle hemodynamic
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In our Cohort, 70% of our patients had an intervention with or without other important new diagnostic information resulted in postponing or excluding from Fontan completion. Our interventional rate was in agreement with the overall rate (69%) reported by the centers participating in C3PO project. Interestingly, interventional rate varies significantly among the all 8 participating center with a range of 50–84% [11].

In addition to the well-known possible acute adverse events of cardiac catheterization [11], there is a growing awareness of long term effect of ionizing radiation. The risk of radiation-related cancer in patient who received radiation during childhood seems to be related to the total radiation dose and it is more prominent in children irradiated early in life. In addition, the risks for solid tumors persisted throughout life. [13]. Due to the above, there is mounting interest to substitute pre-Fontan cardiac catheterization by non-invasive methods
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Despite they concluded the ability of criteria to discriminate patients who could skip catheterization (negative predictive value) was high (93%), 3 out of 46 patients (in whom catheterization deemed to be not indicated) received important transcatheter interventional procedure. In addition, they found that the algorithm is inadequate to detect PA stenosis as well as to assess the presence of significant SPCs. Even though adding magnetic resonance imaging to their algorithm would substantially improve its ability to detect PA stenosis and SPCs collaterals, this was not tested in their work and the validity of their algorithm has not been verified by different

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