The Fontan Operation: What Is It and Waht Is Its Future?

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In 1971. Fontan reported the first successful total right heart bypass that separated the pulmonary and systemic circulation and relieved ventricular volume overload in patients with tricuspid atresia. Since then, many technical modifications of the Fontan operation have been utilized for the heterogeneous group of patients with forms of functional single ventricle. The major lesson learmed after two decades of experience with the Fontan operation is the proper patient selection is essenfial. At many centers around the world. the Fontan operation currently is performed with a relatively low early mortality (3.6%). for patients operated on in the last decade, 5-year survival is 80%. However, postoperative supraventricular arrhythmlas can develop in 30–40% of patients, These arrhythmias frequently are recurrent and difficult to control. Chronic systemic venous hypertension might predispose 13% of postoperative patients to develop enteric protein loss and clinical congestive cardiac fallure. After the Fontan operation, patients require care at tertiary care centers with the medical and surgical expertise to provide meticulous follow-up and sureveillance for late arrhythmias, However, a normal lifestyle including childbearing, employment and athletic participation is expected

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