The Fontan procedure involves connecting which structures?

The Fontan procedure involves connecting which structures?

• A. Right atrial appendage to pulmonary artery
• B. Right atrial appendage to aorta
• C. Right ventricle to pulmonary artery
• D. Left atrial appendage to pulmonary artery

Answer: (A)

The Fontan procedure creates a circulation for patients with single-ventricle physiology by routing systemic venous return directly to the lungs, bypassing the right ventricle. The common and effective way to achieve this is to connect the right atrial appendage to the pulmonary artery, so deoxygenated blood from the body flows passively into the lungs for oxygenation without needing a subpulmonary ventricle. This setup relies on low pulmonary vascular resistance to drive blood forward into the lungs. Connecting the right atrial appendage to the aorta would send desaturated blood into the systemic circulation, which is not the goal. Attaching the right ventricle to the pulmonary artery would still involve pumping to the lungs with a ventricle, undermining the Fontan design. Linking the left atrial appendage to the pulmonary artery would disrupt the normal separation of systemic venous return and pulmonary blood flow.

The Fontan procedure creates a circulation for patients with single-ventricle physiology by routing systemic venous return directly to the lungs, bypassing the right ventricle. The common and effective way to achieve this is to connect the right atrial appendage to the pulmonary artery, so deoxygenated blood from the body flows passively into the lungs for oxygenation without needing a subpulmonary ventricle. This setup relies on low pulmonary vascular resistance to drive blood forward into the lungs. Connecting the right atrial appendage to the aorta would send desaturated blood into the systemic circulation, which is not the goal. Attaching the right ventricle to the pulmonary artery would still involve pumping to the lungs with a ventricle, undermining the Fontan design. Linking the left atrial appendage to the pulmonary artery would disrupt the normal separation of systemic venous return and pulmonary blood flow.