Fontan Surgery, also known as Fontan - Kreutzer procedure, has been named from the names of the respective doctors, who devised this palliative surgery. In patients with an effective single heart chamber, where the blood flow is difficult to be maintained, this process can be carried out as a palliative means of shunting blood from the vena cava to those of the large heart arteries, so that the ventricles do not receive the load of the blood from different parts of the body. In technical terms, this is a surgery done to move the blood from the left side of the heart coming from vena cava and left atrium towards the pulmonary artery. This lets the blood flow directly into the lungs and the right atrium without passing through the left ventricle. Such a surgical procedure is to be undertaken when the valve in between the atrium and ventricle is absent or atresic, thereby converting the two chambers into one. This can be seen in the right part of the heart or in the left side.
Both the cases of hypoplastic right heart and left heart syndrome are very serious congenital conditions. In such scenario, where bilateral repair of the valves may pose danger to the health of the child, or it is impossible to conduct the surgeries, Fontan surgery is the proper methodology to adopt. If the left side is affected, Norwood surgery is done to restore the inadequate blood supply to the lungs or increased supply. Fontan surgery in hospitals in India can be undertaken if the pressure along the pulmonary arteries is low, provided the age of the affected child is more than 2 years. It is simply a method of decompensating the pressure in the ventricles.
Primarily, Fontan surgery in cardiology includes the process as described by Fonton and Kreutzer, which is the arteriopulmonary shunt. But, latter on, certain modifications were done such as lateral tunnel, namely the intracardiac and extracardiac total cavopulmonary connection.
There can be different stages in which the Fontan surgery in India is actually defined for children. It is supposedly done in the simplest form of shunting the blood from vena cava and atrium directly into the lungs, as defined by Fontan initially. There are two types of processes, the internal conduit and the external Fontan.
Apart from the typical Fontan procedure for cardiac congenital diseases, other surgeries are also indicated for the problem of single effective ventricle, although these may be risky for the children.
Since the medical setups in Indian hospitals have improved tremendously, there are many disease conditions, which are being diagnosed and treated accordingly. While many diseases are possible to be treated in outdoor set ups, the surgeries are supposed to be the more difficult ones. Surgery set up in India is also quite excellent, but a few hospitals in South and North India are actually taking up the Fontan surgery because of the highly advanced set up. From across the country, the paediatric cases are being referred to these hospitals, if the cardiologists find the patients fit to undergo Fontan Surgery. Some of the patients have undergone other tests with indications of Fontan surgery in Indian hospitals, but now require palliative care to allow the blood flow to occur. Such an operation has to be done by highly experienced cardiologists and cardiothoracic surgeons, with assistance of few other surgeons and nursing staff.
After the surgery is over, the care of the patient is to be taken properly, to allow the blood to flow into the heart chambers in the right manner, so that the shunts created in this Fontan surgery in India, helps with the longevity and success of the operation.
The Fontan surgery in India will be done with extreme care and precision, so that the decompensated and serious cases can put the patient a few days of bed rest after the surgery. Accordingly, the cost factor required can also be known at this stage, for the guardians of these kids can be worried later on.
In recent times, it has been seen that a larger surgery is done electively, with primary concerns of important advantages for the patients. If the child responds good, there will be significant improvements, especially with the complaints of the patient.
Fortan surgery is one of the best options for children when they develop such a medical complication and the success rate is quite high in such surgeries.