Fontan Procedure

The Fontan procedure is the final one in a series of surgeries performed by Norton Children’s Heart Institute cardiovascular surgeons to treat hypoplastic left heart syndrome (HLHS) or patients with complex single ventricles. Advances in treating single ventricle patients have given more babies the chance to live full lives. For example, hypoplastic left heart syndrome was considered inoperable and fatal before surgeons developed the three-surgery series.

The Fontan procedure is the final one in a series of surgeries to treat hypoplastic left heart syndrome (HLHS) or patients with complex single ventricles. Advances in treating single ventricle patients have given more babies the chance to live full lives. For example, hypoplastic left heart syndrome was considered inoperable and fatal before surgeons developed the three-surgery series.

The goal of the Fontan procedure is to direct blood from the lower part of the body directly to the lungs. The route bypasses the heart preventing deoxygenated blood from mixing with oxygenated blood which previously caused lower oxygen saturations.

The cardiothoracic surgeons at Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, are skilled at rebuilding the heart and redirecting blood flow so the heart isn’t overworked and more oxygen-rich blood is distributed throughout the body.

The board-certified and fellowship-trained cardiothoracic surgeons at Norton Children’s Heart Institute are equipped to perform the Fontan procedure as part of HLHS treatment.

How the Fontan Procedure Works

Surgeons performing the Fontan procedure disconnect the inferior vena cava (the vein that brings blood back from the lower part of the body) from the heart and connect it to the pulmonary artery.

Often, a small hole, called a fenestration, is created between the conduit and the right atrium. This allows some blood to flow directly back to the heart. It acts as a relief valve as the lungs get used to the extra flow from the lower part of the body. The fenestration can be closed later in life with a cardiac catheterization procedure.

With all the connections made, blood from the lower body now goes to the pulmonary artery, and then to the lungs, without having to go to the heart. The patient’s single ventricle now pumps oxygen-rich blood from the lungs out to the body and all the way back through the lungs.

With the high- and low-oxygen blood no longer mixing in the heart because of the defect, more oxygen gets out to the body.

Children who have the Fontan procedure usually spend one to two weeks in the hospital to recover. They also get medicines to help the heart and improve blood flow. The physicians and staff at Norton Children’s Hospital provide around-the-clock care and monitoring.

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What Else You May Need to Know

Many children born with single ventricles thrive and do well after the series of heart surgeries. However, they’ll need to see their pediatric cardiologist, get echocardiograms and occasionally undergo cardiac catheterizations.

To help keep your child as healthy as possible:

  • Go to all doctor visits.
  • Give all medicines as directed.
  • Follow the guidelines from your care team.

 

Sometimes, the three heart surgeries do not completely fix all the issues with the heart, or the single ventricle can wear out because it is always performing the workload of two ventricles. In these cases, a child may need a heart transplant.

Why Choose Norton Children’s Heart Institute

No other congenital heart surgery program in Kentucky, Ohio or Southern Indiana is rated higher by the Society of Thoracic Surgeons than the Norton Children’s Heart Institute Pediatric Cardiothoracic Surgery Program.

  • Norton Children’s Hospital is a pioneer in pediatric cardiothoracic surgery, performing Kentucky’s first pediatric heart transplant in 1986 and becoming the second site in the United States to perform an infant heart transplant.
  • Our board-certified and fellowship-trained pediatric cardiovascular surgeons are leaders in the field as clinicians and researchers.
  • More than 5,000 children a year visit Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, for advanced heart care.
  • Norton Children’s Heart Institute successfully performs more than 17,500 procedures a year.
  • The Society of Thoracic Surgeons rated Norton Children’s Heart Institute among the best in the region after studying years of our patients’ outcomes and our ability to treat a range of pediatric heart conditions, including the most severe.
  • Norton Children’s Heart Institute has satellite outpatient offices in Ashland, Bowling Green, Campbellsville, Elizabethtown, Frankfort, London, Madisonville, Murray, Owensboro, Paducah and Shepherdsville in Kentucky; as well as Corydon, Jasper, Madison and Scottsburg in Indiana; 28 tele-echocardiography locations in Kentucky and Southern Indiana; and six fetal echocardiography locations across Kentucky.
  • The American Board of Thoracic Surgery has awarded the cardiothoracic surgeons at Norton Children’s Hospital with subspecialty certification in congenital heart surgery.
  • The Jennifer Lawrence Cardiac Intensive Care Unit (CICU) is the largest dedicated CICU in Kentucky, equipped with 17 private rooms and the newest technology available for heart care.
  • Our multidisciplinary approach to pediatric heart surgery brings together our specialists in cardiothoracic surgery, cardiology, anesthesiology, cardiac critical care and other areas to create a complete care plan tailored for your child.
A child with a single ventricle defect also needs the Fontan procedure because of these reasons.
An illustration shows changes to the IVC during the Fontan procedure
An illustration shows the right ventricle after the Fontan procedure
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Norton Children’s Heart Institute

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