{"title":"Partial heart transplantation can provide a pulsatile and growing Fontan conduit: A rightward shift for a better Fontan","authors":"Harma K. Turbendian , Taufiek Konrad Rajab","doi":"10.1016/j.mehy.2025.111694","DOIUrl":null,"url":null,"abstract":"<div><div>The total cavopulmonary connection, more commonly known as the Fontan-Kreutzer procedure, is the final surgical step in the palliation of single ventricle congenital heart defects. The overwhelming success of the Fontan procedure has resulted in a worldwide population of 50,000 to 70,000 patients with a Fontan procedure. However, the resultant Fontan physiology, characterized by parallel systemic and pulmonary circuits, inevitably results in fatal long-term complications as a result of passive, nonpulsatile pulmonary blood flow, inefficient hemodynamics, and static conduit size which are inherent to the Fontan. Partial heart transplantation has dramatically altered the landscape of congenital heart surgery by providing a source of semilunar valve implants with the potential for growth and self-repair. Here we hypothesize that partial heart transplantation of the right atrium can provide a novel Fontan conduit which is pulsatile, has growth potential, low thrombogenicity, and optimal flow dynamics.</div></div>","PeriodicalId":18425,"journal":{"name":"Medical hypotheses","volume":"201 ","pages":"Article 111694"},"PeriodicalIF":2.1000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical hypotheses","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0306987725001331","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
引用次数: 0
Abstract
The total cavopulmonary connection, more commonly known as the Fontan-Kreutzer procedure, is the final surgical step in the palliation of single ventricle congenital heart defects. The overwhelming success of the Fontan procedure has resulted in a worldwide population of 50,000 to 70,000 patients with a Fontan procedure. However, the resultant Fontan physiology, characterized by parallel systemic and pulmonary circuits, inevitably results in fatal long-term complications as a result of passive, nonpulsatile pulmonary blood flow, inefficient hemodynamics, and static conduit size which are inherent to the Fontan. Partial heart transplantation has dramatically altered the landscape of congenital heart surgery by providing a source of semilunar valve implants with the potential for growth and self-repair. Here we hypothesize that partial heart transplantation of the right atrium can provide a novel Fontan conduit which is pulsatile, has growth potential, low thrombogenicity, and optimal flow dynamics.
期刊介绍:
Medical Hypotheses is a forum for ideas in medicine and related biomedical sciences. It will publish interesting and important theoretical papers that foster the diversity and debate upon which the scientific process thrives. The Aims and Scope of Medical Hypotheses are no different now from what was proposed by the founder of the journal, the late Dr David Horrobin. In his introduction to the first issue of the Journal, he asks ''what sorts of papers will be published in Medical Hypotheses? and goes on to answer ''Medical Hypotheses will publish papers which describe theories, ideas which have a great deal of observational support and some hypotheses where experimental support is yet fragmentary''. (Horrobin DF, 1975 Ideas in Biomedical Science: Reasons for the foundation of Medical Hypotheses. Medical Hypotheses Volume 1, Issue 1, January-February 1975, Pages 1-2.). Medical Hypotheses was therefore launched, and still exists today, to give novel, radical new ideas and speculations in medicine open-minded consideration, opening the field to radical hypotheses which would be rejected by most conventional journals. Papers in Medical Hypotheses take a standard scientific form in terms of style, structure and referencing. The journal therefore constitutes a bridge between cutting-edge theory and the mainstream of medical and scientific communication, which ideas must eventually enter if they are to be critiqued and tested against observations.