RESUMEN
The Fontan procedure is the final procedure in staged palliation for patients with functional single-ventricle physiology. The goal of the procedure is to separate systemic and pulmonary blood flow by directing systemic venous return through the Fontan connection to the pulmonary arteries and the lungs without ventricular contribution. Following the procedure, pulmonary blood flow is completely passive and dependent on pressure gradients, resulting in complex postoperative cardiopulmonary interactions. Understanding the physiology is essential to effectively manage these patients. Critical care nurses caring for patients after a Fontan procedure must understand preoperative data, risk factors, and unique postoperative physiology so they can anticipate specific postoperative problems, recognize trends in clinical status, and develop an appropriate plan of care. This paper reviews the first 2 stages of single-ventricle palliation, relevant modifications to the Fontan procedure, important preoperative cardiac catheterization data, common postoperative problems, and outcomes after the Fontan procedure.
Asunto(s)
Enfermería de Cuidados Críticos/normas , Procedimiento de Fontan/métodos , Procedimiento de Fontan/enfermería , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/cirugía , Guías de Práctica Clínica como Asunto , Arteria Pulmonar/cirugía , Adolescente , Niño , Preescolar , Educación Continua en Enfermería , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Cuidados Posoperatorios/enfermería , Cuidados Preoperatorios/enfermería , Factores de RiesgoAsunto(s)
Procedimiento de Fontan/enfermería , Cardiopatías Congénitas/enfermería , Atresia Tricúspide/enfermería , Adolescente , Niño , Preescolar , Estudios de Seguimiento , Procedimiento de Fontan/mortalidad , Cardiopatías Congénitas/mortalidad , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Recién Nacido , Tasa de Supervivencia , Atresia Tricúspide/mortalidad , Atresia Tricúspide/cirugíaRESUMEN
Congenital heart surgery is an evolving field. As techniques improve and procedures are modified, enhanced patient outcomes are evident. Technological advancements, pharmacologic interventions, and hemodynamic support provide better patient outcomes. Hypoplastic left heart syndrome (HLHS) is one of many complex, poorly understood congenital heart defects presenting in the first weeks of life. It causes 25% of infant deaths. This article presents a staged approach for intervention in neonates with HLHS.
Asunto(s)
Procedimiento de Fontan/métodos , Síndrome del Corazón Izquierdo Hipoplásico/cirugía , Procedimiento de Fontan/enfermería , Humanos , Síndrome del Corazón Izquierdo Hipoplásico/diagnóstico , Síndrome del Corazón Izquierdo Hipoplásico/epidemiología , Incidencia , Lactante , Cuidado Intensivo Neonatal/métodos , Enfermería Neonatal/métodos , Atención Perioperativa/métodos , Atención Perioperativa/enfermería , Diagnóstico Prenatal/métodos , Pronóstico , Factores de Riesgo , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Children with single ventricle anatomy are among the most complicated and challenging patients encountered in pediatric cardiology. Current management involves staged surgical procedures, beginning with neonatal palliation and followed by a bidirectional cavopulmonary anastomosis in infancy and culminating in the Fontan procedure. The Fontan procedure, despite separating the circulation, remains a palliative procedure with many long-term concerns. This report discusses the staged surgical management of patients with single ventricle anatomy and the nursing issues relevant to each stage.