The Fontan procedure: evolution in technique; attendant imperfections and transplantation for "failure"

Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2011;14(1):55-66. doi: 10.1053/j.pcsu.2011.01.014.


Application of the Fontan procedure has allowed the survival of many patients with univentricular cardiac lesions into mid adulthood. Despite its ingenious design, implementation, and thoughtful modifications, its attendant hemodynamic perturbations persist; central venous hypertension and reduced cardiac output. These aberrations in physiology have led to pernicious changes in organ function. A more thorough understanding of these derangements and attempts at Fontan revision have temporized, yet the morbidity and patient attrition persists. Mechanical assistance to normalize the circulation is being investigated and holds some promise. At present, cardiac transplantation remains the last stage of palliation for many.

Publication types

  • Review

MeSH terms

  • Age Factors
  • Female
  • Fontan Procedure / adverse effects
  • Fontan Procedure / methods*
  • Fontan Procedure / mortality
  • Heart Defects, Congenital / diagnosis
  • Heart Defects, Congenital / mortality
  • Heart Defects, Congenital / surgery*
  • Heart Transplantation*
  • Heart Ventricles / abnormalities*
  • Heart Ventricles / surgery
  • Hemodynamics / physiology
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Prognosis
  • Risk Assessment
  • Survival Analysis
  • Time Factors
  • Treatment Outcome