Kerala: SCTIMST gets Fontan Clinic for complex univentricular congenital heart diseases

Kerala: The Division of Pediatric Cardiology, under the Department of Cardiology, proposes the organization of a new focused clinic for outpatient care within the outpatient block of the Department of Cardiology – "Fontan Clinic". The Fontan Clinic shall be a dedicated clinic for the evaluation and management of patients who have undergone total cavopulmonary connection (TCPC), commonly referred to as the Fontan surgery, the destination surgery of a series of surgeries for complex univentricular congenital heart diseases.

The Congenital Heart Services Team of SCTIMST including the Departments of Cardiology, Cardiovascular and Thoracic Surgery, Cardiac Anesthesiology and Imaging Sciences, and Interventional Radiology have vast expertise in treating complex congenital heart diseases. SCTIMST has over 200 patients who have undergone all stages of univentricular palliation, and the number is ever increasing. 

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The Division of Pediatric Cardiology, under the Department of Cardiology, is taking the onus of advancing the comprehensive rehabilitation of these patients by organizing a dedicated clinic facility that envisages multi-disciplinary collaboration and focused care of these patients. This is set to be the first dedicated clinic for Fontan patients in the country.

The need for a Fontan clinic:

The Fontan pathway was a milestone in the palliation of children born with complex univentricular heart diseases 90% of who would not have survived beyond their first birthday without intervention. While the procedure permits longer survival of these patients, this circulation involves several compromises from normal human circulation and poses several challenges with increasing age after surgery. Since a normal two-pumped heart that supports human circulation is not feasible for these patients, they are palliated into a phylogenetically lower single-pump circulation to meet the requirements of the body. While the ideal Fontan circulation does very well for a long, it is not unusual for other organ systems like the liver, kidney, lungs, and gut to present with issues with the newly fashioned circulation. Therefore it is important for patients to be followed up regularly by a Cardiologist and other specialists to find any problems early when treatment is most effective.

Aims of the clinic:

1. Comprehensive rehabilitation and follow-up of children and adults who have undergone Fontan surgery. Implementation of measures to improve the quality of life of these patients by timely consideration for additional investigations as required, including advanced imaging and cardiac catheterization. This shall be implemented by a validated checklist, ratified by the Joint Cardiac Team in Congenital Heart Services of the institute.

2. Implementation of holistic care for these patients by involving all divisions of Cardiology, the departments of Cardiac Surgery, Cardiac Anesthesiology, Physical Medicine and Rehabilitation specialists, Vascular surgery from SCTIMST, and Respiratory Medicine, Nephrology, Gastroenterology, and Endocrinology consultants whenever required.

3. Formation of a registry of patients with univentricular congenital heart diseases who have undergone Fontan completion.

4. The Fontan Clinic shall also serve as a portal for second opinion and consultations with other providers. This shall be done by the Telemedicine system of SCTIMST.

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