Fontan completion
Clinical Procedure
 
Aliases:
Fontan second stage
total cavopulmonary anastomosis

Topic aliases are alternate phrasings for a particular topic.


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Considerations as for patients undergoing a redo sternotomy and paediatric cpb

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General considerations as for patient's with a fontan circulation

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Generally performed at 3-5 yrs of age when the proportion of blood flow from the IVC begins to increase due to the relative decrease in the size of the head and increase in lower limb muscle activity in the walking child. #improve

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Aug 13, 2012
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In patients that have previously undergone kawashima procedures ( BCPC in patients with interrupted IVC) as the stage 1 procedure, the Fontan procedure is usually undertaken earlier than usual.

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Timing of this procedure is a balance between :
1. avoiding formation of collateral venous circulation (eg intrapulmonary venous malformations),
2. coping for as long as possible with progressive functional limitation
3. the natural limitation of the durability of the fontan circulation and
4. the cumulative risk of embolic stroke events

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Intraoperative TOE/TEE is usually performed.

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Sep 08, 2012
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The goal following a fontan completion is early extubation to minimise the effect of IPPV on intrathoracic pressures and venous return.

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The fontan position is used in picu to optimise pulmonary blood flow
The head is elevated to 45 degrees and the legs are placed on a pillow

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Aug 14, 2012
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Fontan completions often come off the table on a vasoconstrictor such as noradrenaline

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In the immediate hours following the fontan completion the patients will usually need a combination of filling (20-30ml/kg) and peripheral vasocontriction to manage post bypass vasodilation.

If 40ml/kg or more fluid is required consider other causes of hypotension.

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A clear prime for the bypass circuit is often possible in the patients undergoing a fontan completion as the patients are usually polycythaemic.
Dilution of the patient's hemaglobin in the bypass circuit results in acceptable post-dilution hemaglogin.
This minimises the exposure to exogenous blood transfusion.

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