Experimental right heart bypass operations have influenced the evolution of current application of the Fontan procedure. In this review, we summarize the evolution and progress of the experimental Fontan operation (FO) and discuss the questions raised so far. The evolution and progress of the experimental FO is analyzed in this review by collecting data retrieved from English literature research. The establishment of Fontan circulation on an experimental animal model is extremely difficult and until today, a chronic experimental model has never been described. Computational fluid dynamics (CFD) has played a significant role in the investigation of the hemodynamic characteristics of the FO and has been applied to the design and integration of the procedure. CFD was also employed to evaluate the performance of assisted Fontan circulation. Accumulated experience from the experimental studies and clinical practice, in combination with the cooperation of different fields in medicine and positive sciences, are definitely expected to help the evolution furthermore.
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http://dx.doi.org/10.5761/atcs.ra.13-00017 | DOI Listing |
Eur Heart J Case Rep
January 2025
Cardiac Electrophysiology, National Medical Center 'November 20th', ISSSTE, Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, C.P. 03100 Mexico City, Mexico.
Background: The 'univentricular' heart encompasses a variety of congenital cardiac defects characterized by a single functional ventricle and an underdeveloped ventricular chamber. Surgical intervention, typically in infancy or childhood, aims to regulate pulmonary blood flow volume. In adulthood, untreated patients may experience limitations in physical activity and elevated morbidity due to persistent cyanosis and arrhythmias, notably after the Fontan procedure.
View Article and Find Full Text PDFWorld J Pediatr Congenit Heart Surg
January 2025
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Background: With an increasing number of Fontan patients surviving into adulthood, the burden of end-stage heart failure is increasing. Prior studies have reported suboptimal heart transplantation (HTx) outcomes. Therefore, the authors describe their institutional experience of HTx in patients with Fontan circulation failure, including heart-liver transplantation (HLTx) and pretransplant systemic ventricular assist device (SVAD) therapies.
View Article and Find Full Text PDFAdv Clin Exp Med
January 2025
Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland.
Background: We still know little about the effective pharmacological treatment of heart failure (HF) associated with the Fontan circulation. One of the new options may be sodium glucose cotransporter-2 inhibitors (SGLT2i), which have been proven effective in classic forms of left ventricular HF.
Objectives: To evaluate the effect and safety of SGLT2i inclusion in adults with Fontan circulation.
J Thorac Cardiovasc Surg
January 2025
Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan. Electronic address:
Objective: The modified Fontan operation, a palliative approach for single ventricular circulation patients, often incorporates a fenestration to facilitate postoperative management. Postoperative fenestration closure is sometimes performed to mitigate potential risks such as low oxygen saturation. However, the benefits and potential risks of this procedure remain under investigation.
View Article and Find Full Text PDFCan J Cardiol
January 2025
Research Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada; Adult Congenital Heart Centre, Montreal Heart Institute, Université de Montréal, Montreal, Canada. Electronic address:
In congenital heart diseases (CHD) of moderate to great complexity involving the right ventricle (RV), the morphologic RV can be exposed to significant stressors across the lifespan either in a biventricular circulation in a sub-pulmonary or sub-aortic position, or as part of a univentricular circulation. These include pressure and/or volume overload, hypoxia, ischemia, and periprocedural surgical stress leading to remodeling, maladaptation, dilation hypertrophy and dysfunction. This review examines the macroscopic remodeling of the RV in various forms of CHD and explores remodeling trajectories, along with the effects of surgeries and residual lesion repair, in tetralogy of Fallot, Ebstein anomaly, congenitally corrected transposition of the great arteries, transposition of the great arteries with atrial switch surgery, and single ventricle palliated by Fontan.
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