Fontan Procedure - Post-operative Complications

Post-operative Complications

In the short term, children can have trouble with pleural effusions, fluid building up around the lungs. This can require a longer stay in the hospital for drainage with chest tubes. To address this risk, some surgeons make a fenestration (a small hole) from the venous circulation into the atrium. When the pressure in the veins is high, some of the oxygen-poor blood can escape through the fenestration to relieve the pressure. However, this results in hypoxia, so the fenestration may eventually need to be closed by an interventional cardiologist.

In the long term, children can have trouble with atrial flutter and atrial fibrillation because of scarring in the atrium, especially if the connection of IVC to pulmonary arteries involved an intracardiac baffle (instead of an extracardiac conduit). This sometimes requires treatment such as radiofrequency ablation. There are other long-term risks, including protein-losing enteropathy and chronic renal insufficiency, although understanding of these risks is still incomplete. Some patients require long-term blood thinners.

The Fontan procedure is palliative, not curative. But in many cases it can result in normal or near-normal growth, development, exercise tolerance, and good quality of life. In most cases, patients will eventually require heart transplantation.