Has the doctor told you to have a Fontan procedure on your child? Don't worry, let's talk about it.

When your doctor tells you that your little one needs to have a Fontan Procedure due to a congenital heart condition, you may feel a great sense of dread and fear. A thousand questions may suddenly come to mind. It is very normal to think things like, "What kind of surgery is that?", "Why is my child going through this?", "Will he be okay after this?" Don't worry. Let's talk about this calmly and clearly. In this article, I will try to answer your questions about this in a simple way.

Simply put, what is the Fontan Procedure?

To understand this, let's first remember a little about how our heart works. A healthy heart has four main chambers. Two on top and two on the bottom. We call the two large, strong chambers below these ventricles . One chamber collects the body's oxygen-poor, "dirty" blood and pumps it to the lungs to get oxygen. The other chamber collects the oxygen-rich, "clean" blood from the lungs and pumps it to the rest of the body. These two work like two water motors.

However, when some children are born, one of these two cells is not fully developed. Then, the only good cell has to do both these jobs. That is, it has to pump blood to the lungs and to the whole body. Imagine how much weight that motor feels when it has to pump water to two houses with one motor. So, this single cell has to work under a heavy load.

Here's what the Fontan procedure does : Surgeons create a small "shortcut" to the heart. This allows oxygen-poor blood from the lower body to flow directly to the lungs, bypassing the heart. It essentially bypasses some of the heart's heavy traffic.

What kind of children are this surgery performed on?

The Fontan operation is not a one-time procedure. It is usually performed as the third and final step in a series of surgeries for a child with a single-chamber heart defect. Before that, one or more other surgeries may be required, depending on the child's age and condition.

Main conditions requiring Fontan surgery

This surgery is mainly needed in a few cases where the heart is not properly formed at birth. These are:

• Hypoplastic left heart syndrome: This is the most common cause. In this condition, the left side of the heart does not develop properly.
• Hypoplastic right heart syndrome: In this condition, the right side of the heart does not develop properly.
• Tricuspid atresia: A valve on the right side of the heart is not properly formed.
• Pulmonary atresia: The valve that carries blood to the lungs is blocked.
• Double inlet left ventricle: Blood from both upper chambers of the heart enters only the left ventricle.
• Several other complex congenital heart conditions.

These names may make you feel even more scared. But these are just the names that doctors use to identify you. The important thing is that in all of these conditions, a single heart valve is under too much strain. The Fontan procedure attempts to relieve that strain.

What happens before the surgery?

Fontan surgery is usually performed on a child between the ages of 2 and 5. Sometimes it can be delayed until the child is about 15 years old. However, this surgery cannot be performed on everyone. Doctors will first perform several tests to see if your child is suitable for this surgery.

For example, the child's working single cell must be strong enough to pump well. Also, the lungs must be healthy enough to accept the incoming blood directly without the help of the heart.

The following tests are performed before surgery:

• Transthoracic echocardiogram (TTE): This is like a scan of the heart. It can clearly see the heart's chambers, valves, and blood flow.
• Electrocardiogram (EKG): This tests the electrical activity of the heart, that is, the heartbeat pattern.
• Heart catheterization: A very thin tube (catheter) is passed through a blood vessel in the leg or arm to the heart, and the pressure and oxygen levels inside the heart are measured. This can provide a very accurate picture of the condition of the heart before surgery.
• Checking breathing and oxygen levels.
• Sometimes CT or MRI scans.

All of these tests are done to make the surgery as safe and successful as possible.

What happens during the surgery?

In the operating room, the child is first given anesthesia to put him or her to sleep so that he or she does not feel any pain. During the surgery, a heart-lung machine is used to temporarily do the work of the heart and lungs.

The surgeon then connects the inferior vena cava, the main blood vessel that carries oxygen-poor blood from the lower body, to the pulmonary artery, which carries blood to the lungs, using a conduit. This is how the "shortcut" we talked about earlier is created.

Sometimes, other minor repairs, such as repairing a heart valve, can be done at the same time as this surgery.

The entire surgery can usually take about four to five hours . During that time, the medical team will talk to you regularly and provide updates on your child's condition.

What are the benefits and risks of the surgery?

Like any surgery, Fontan surgery has benefits as well as some risks.

The main advantage is that it reduces the workload on the heart, making its job much easier. Also, since there is less mixing of oxygen-rich and low-oxygen blood, the amount of oxygen that the body receives increases. The child's lips and fingernails become blue (cyanosis) less, and he has more energy to be more active.

These things can be scary to see, but remember, the medical team is aware of all these risks. They are constantly prepared to prevent them and manage them if they occur.

How is life after the surgery?

After the surgery, the child is admitted to the intensive care unit (ICU) and closely monitored. After a few days, when the condition improves, they are transferred to a general ward. A child may stay in the hospital for a total of 7 to 13 days .

Before you go home, the doctors and nursing staff will explain to you in detail how to care for your baby, the medications to be given, and the symptoms to watch out for.

When do you need to talk to the doctor?

After returning home, you should call your doctor immediately if you notice any of these symptoms:

• If blood or other fluid is leaking from the surgical wound.
• If you have a fever or other signs of infection (fever, swelling, redness).
• If breathing difficulty increases.

A child who has had a Fontan operation will need lifelong medical care. They will usually need to see a doctor every 6 to 12 months . They will also need regular tests to check the condition of their heart and liver.

What can you say about lifespan?

This is a big question for many parents. Life expectancy after Fontan surgery depends on the severity of the congenital heart condition the child had.

But, today, medicine has advanced a lot. Most people live 10 years after surgery. Eight out of ten people live 30 years or more . In fact, many people who have had a Fontan operation now live well into their 40s and beyond.

Over time, some people's heart's pumping ability may weaken, or the liver may be affected. This is called a "failed Fontan." In such cases , a heart transplant may be needed. But not everyone needs this.

When you find out that your child has a serious heart condition and is about to undergo surgery, you may feel a lot of emotions. Fear, anxiety, and uncertainty about the future are all normal. But the most important thing to know is that you are not alone .

After this surgery, your child can play, learn, grow, and enjoy life just like any other child. They may get tired more quickly, or they may need additional medical tests. But, with the right medical advice and your love and care, they can live a full, happy life.