Cardiologia Clínica e Experimental
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The Promises of Pulmonary Pulsatility-Should we Leave in Forward Flow in the Fontan Operation?

Robert Michael Rhys Tulloh, Kritika Kalia*

The contemporary Fontan operation has revolutionised the management of complex congenital heart disease. Despite its unrivalled success, a substantial burden of disease persists in the growing adult Fontan population. There is accruing evidence to suggest that complications late after Fontan may reflect inadequate preparation during earlier staging operations. To this effect, there has been a paradigm shift towards strategies which aim to optimise the anatomy and physiology during the palliation process. The role of maintaining anterograde pulmonary blood flow has garnered substantial interest in recent years; however, despite an expanding evidence base, there is an absence of studies which attempt to correlate haemodynamic with clinical outcome data. This communication reports the findings of our recent retrospect cohort study and contextualises this within the growing body of literature. Looking to the future, randomised controlled trials remain highly unlikely; however, we propose solutions which monopolise on the expeditious advancements possible in today’s technological era, to affect further improvement in this area of unmet clinical need.