Does your baby have only one heart cell? Let's learn about the Fontan Procedure.

Was your little one born with a complex heart problem? Sometimes doctors may have told you that your baby's heart has only one main pump, a ventricle. A special surgery that doctors recommend in such cases is called the 'Fontan procedure'. It's actually very normal to feel scared and uncertain when you hear this name. But if we are fully aware of this, you will gain great strength and energy to go on this journey. Shall we talk about this simply?

What is the Fontan Procedure in simple terms?

To understand this, let's first take a look at how a healthy heart works. A healthy heart has four main chambers. Two on top (atria) and two on the bottom (ventricles). These two chambers are the heart's two main pumps. One sends oxygen-poor, impure blood to the lungs to pick up oxygen. The other pumps oxygen-rich, clean blood to the rest of the body.

However, some babies are born with one of these two cells not properly formed. Then the single cell that does the work has to do both these jobs. Imagine how tiring it is for the same person to have to do two jobs. Just like that, this single cell can quickly become tired because it has to pump blood to both the lungs and the body.

In this procedure, surgeons connect oxygen-poor blood from the lower body to the pulmonary artery, bypassing the heart. This is like creating a new 'shortcut'. Usually, before this procedure, another procedure called the Glenn procedure is performed to direct oxygen-poor blood from the upper body to the lungs. The Fontan procedure is the final step in this series of procedures.

When new pathways are created in this way, the only job of that single cell is to pump clean, oxygen-rich blood throughout the body. This is a great relief for that little heart.

Who needs this surgery and why?

This surgery is mainly performed on children born with a single ventricle. It is usually performed between the ages of 2 and 5 .

But this surgery is not for everyone. The doctor will carefully examine your child to see if he or she is suitable for this. For example:

• The child's working cell needs to be very strong.
• The lungs must be healthy enough to receive blood coming directly to the lungs.

The table below lists some of the main heart conditions treated with this surgery.

What happens before and during the surgery?

After deciding that your child is suitable for surgery, the doctor will perform several tests.

• Transthoracic Echocardiogram (TTE): This is an ultrasound scan of the heart. It gives a good picture of the heart's structure, valves, and function.
• Electrocardiogram (EKG): Measures the electrical activity of the heart.
• Heart Catheterization: A small tube (catheter) is passed through a blood vessel into the heart to measure the pressure and oxygen levels inside the heart.
• CT or MRI Scan: In some cases, this is necessary to obtain three-dimensional (3D) images of the heart and surrounding blood vessels.

On the day of the surgery, the child is given anesthesia to put him or her to sleep. This means that the child will not feel any pain. During the surgery, the child will be connected to a special machine that temporarily does the work of the heart and lungs (heart-lung machine) . This machine will supply blood to the body until the surgeon makes the new connection (from the inferior vena cava to the pulmonary artery).

Sometimes the surgeon leaves a small hole (fenestration) in the new passageway. This is done to reduce the pressure on the heart after the surgery. The entire surgery can take about 4-5 hours .

What happens after the surgery? Are there any risks?

After the surgery, the child is admitted to the intensive care unit (ICU) for close observation. After a few days, they are transferred to a regular ward. The average hospital stay is between 7 and 13 days .

This surgery has its benefits as well as risks and complications, and it is very important to be aware of them.

Over time, some patients may experience a decrease in the effectiveness of this surgery. This is called a 'failed Fontan'. At that point, a heart transplant may be necessary. Doctors consider this part of the journey.

What kind of future can the child hope for?

In the past, the future of a child born with a single cell was uncertain. But today, with the advancement of medical science, the Fontan operation has given these children the opportunity to move beyond childhood, into youth, and into adulthood.

According to statistics, of those who have had the Fontan operation:

• About 90% are alive after 10 years.
• About 85% are alive after 30 years.

Many people are now living healthy lives beyond the age of 50. But the most important thing is that these children should be under the supervision of a cardiologist throughout their lives . It is imperative to undergo regular tests and check-ups.

When do you need to see the doctor?

When you return home after surgery, notify your doctor immediately if you have any of the following symptoms:

• If blood or other fluid is leaking from the surgical wound.
• If you have a fever or other signs of infection (cough, cold).

Since your child's condition is complex, don't be afraid to ask the doctor about anything you don't understand. Having a good understanding of your child's condition will help you take good care of your child.

Fontan procedure, single ventricle, congenital heart disease, pediatric heart surgery, Hypoplastic Left Heart Syndrome