Fontan Clinic Looks Beyond the Heart

The specialists in this Heart Institute clinic rely on partnerships with other disciplines to treat the many organ systems affected by a Fontan circulation.

When a Fontan procedure is used to redirect the circulation of an individual’s heart, organs other than the heart are affected. This is a fundamental concept that the Fontan Management Clinic at Cincinnati Children’s bases their work on.

As children grow into adulthood, those with a Fontan circulation often experience serious complications of the liver. The lungs, kidney and bowels may also be affected. In addition, neural or cortical impairment can occur and may affect quality of life at many different levels.

Collaborating with Other Experts

“Given the impact of a Fontan beyond the heart, the Fontan Management team has developed a comprehensive program that includes partnerships with specialists throughout Cincinnati Children’s to address the associated conditions these patients encounter,” says Andrew Redington, MD, executive co-director of the Heart Institute, chief of Pediatric Cardiology and interim medical director of ACHD. “One of the key strengths of the program is the expertise in the interaction between the heart and liver. The treatment options offered here with respect to the liver are extensive.”

Part of this multidisciplinary care extends beyond the walls of Cincinnati Children’s to the adult transplant team and adult hepatology team at the University of Cincinnati Medical Center, allowing the group to provide pediatric and adult care, all in one place. The team’s coordination of care streamlines the number of visits patients need to make to the hospital.

Oftentimes, patients who come here are in need of advanced therapies such as ventricular assist devices (VAD) or transplants. A team led by David L.S. Morales, MD, and Angela Lorts, MD, was the first to successfully implant a VAD in a patient with a Fontan in December 2017, resulting in a significant improvement in the adult patient’s health.

Setting Out to Learn Even More

Research continues to be a strength for this team as well, with studies underway on early risk stratification in patients with a Fontan and the effects of drug therapy on the Fontan circulation. In addition, the team has made significant advancements in caring for these patients by developing screening protocols that have translated into earlier diagnoses. This therefore means the program can offer more treatment options.  

“We are fortunate in that we have a very talented group of people here who can offer their unique expertise to this very challenging group of patients,” says Redington. “And they work collaboratively with their referring doctors to provide optimal care to patients from all over the country and overseas.”

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