The Fontan circulation: who controls cardiac output?

Interact Cardiovasc Thorac Surg. 2010 Mar;10(3):428-33. doi: 10.1510/icvts.2009.218594. Epub 2009 Dec 7.


In a Fontan circuit the mechanisms involved in control of cardiac output at rest and during exercise differ significantly from normal. The classical model presumes an unlimited preload which is not available in the Fontan circuit. This review critically analyses the role of contractility, heart rate, and afterload and highlights the importance of pulmonary vascular resistance (PVR) in determining adequate preload and, therefore, cardiac output in these patients. A conceptual model of the determinants of cardiac output in Fontan patients is presented.

Publication types

  • Review

MeSH terms

  • Cardiac Output*
  • Exercise
  • Fontan Procedure* / adverse effects
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery*
  • Heart Rate
  • Humans
  • Models, Cardiovascular
  • Myocardial Contraction
  • Pulmonary Circulation
  • Treatment Outcome
  • Vascular Resistance