Evolutionary Process of the Fontan-Kreutzer Procedure

BACKGROUND The evolutionary process that led to the Fontan-Kreutzer (FK) procedure was determined by the evolution of thought in pediatric cardiology since the pioneer Dr. Rodolfo O. Kreutzer created the cardiology department, with the support of Dr. Alberto Rodríguez Coronel in charge of catherization laboratory and anatomic pathologic department in the hands of Dr. Luis Becú. The first atriopulmonary anastomosis (APA) was carried out in our enviroment without having knowledge of the Fontan work, who claimed the right atrium (RA) “ventricularization” by placing an inlet valve in the inferior vena cava (IVC). Our beginning was different, because it was based on the concept that the end-diastolic pressure of the main ventricle is the suction hemodynamics propellant source of this system.We never place a valve in the IVC and from the beginning we developed the concept of fenestration as atrial escape valve. In 1971 we describe two techniques of APA (one with homograft and the other with the patient’s own pulmonary artery) and in 1978, a posterior direct APA as large as possible, without any valvular implant. Afterwards, from 1987, new and improved surgical techniques have been developed: the lateral tunnel (LT) and extracardiac conduit (EC), which have the advantage of being a conduit that does not cause loss of kinetic energy, as RA would do it, which is a volume chamber. Clearly, the FK procedure is the best option that we may offer today to the single ventricles (SVs), though certainly it is not easy to live with a single ventricle. In many patients, over time, it uses to present a progressive impairment of the system due to chronic low-output and the increase of central venous pressure (near the limit of the edema). However, this impairment does not occur in all cases, as it is shown by the longest-lived survivor of the world after 35 years with this system. Indeed, the FK procedure is a palliative surgery that determined one of the achievement in congenital cardiopathy surgery.