Volume load paradox while preparing for the Fontan: not too much for the ventricle, not too little for the lungs

a Paediatric and Congenital Cardiology, University Hospitals Leuven, Herestraat 49, B 3000 Leuven, Belgium b Paediatric Cardiology, University of the Free State, South Africa *Corresponding author. Tel.: +32 16 343865; fax: +32 16 343981. E-mail address : marc.gewillig{at}uzleuven.be (M. Gewillig). Ventricular dysfunction is frequently encountered in Fontan patients. Cardiologists and cardiac surgeons have, therefore, mainly focused on preservation of cardiac function, limiting the early volume overload as much as possible both in magnitude and duration. This resulted in improved cardiac function but, in some patients, also in poor pulmonary artery (PA) growth which in turn resulted in a poor final Fontan circuit. The volume requirements for optimal growth and development of the ventricle and the lungs are different and divergent. Avoiding overload of the ventricle is important, but excessive protection from volume overload may not be necessary and may result in PA hypoplasia, which in turn will severely affect the Fontan circuit. Key Words: Univentricular heart; Fontan circulation; Cavo pulmonary connection; Palliation; Growth and resistance pulmonary arteries