RESUMO
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.
Assuntos
Enfermagem de Cuidados Críticos/normas , Técnica de Fontan/métodos , Técnica de Fontan/enfermagem , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/cirurgia , Guias de Prática Clínica como Assunto , Artéria Pulmonar/cirurgia , Adolescente , Criança , Pré-Escolar , Educação Continuada em Enfermagem , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Cuidados Pós-Operatórios/enfermagem , Cuidados Pré-Operatórios/enfermagem , Fatores de RiscoAssuntos
Técnica de Fontan/enfermagem , Cardiopatias Congênitas/enfermagem , Atresia Tricúspide/enfermagem , Adolescente , Criança , Pré-Escolar , Seguimentos , Técnica de Fontan/mortalidade , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Recém-Nascido , Taxa de Sobrevida , Atresia Tricúspide/mortalidade , Atresia Tricúspide/cirurgiaRESUMO
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.
Assuntos
Técnica de Fontan/métodos , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Técnica de Fontan/enfermagem , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico , Síndrome do Coração Esquerdo Hipoplásico/epidemiologia , Incidência , Lactente , Terapia Intensiva Neonatal/métodos , Enfermagem Neonatal/métodos , Assistência Perioperatória/métodos , Assistência Perioperatória/enfermagem , Diagnóstico Pré-Natal/métodos , Prognóstico , Fatores de Risco , Taxa de Sobrevida , Resultado do TratamentoRESUMO
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.
