NEW LIFE GIVEN: Acibadem Sistina Hospital Performed Fontan Procedure in a Child for the First Time in Macedonia


Fontan Procedure was performed in a child at the Acibadem Sistina Hospital this month. This intervention is the first such operation in the country, and is performed in children born with univentricular heart. Dr. Vladimir Chadikovski says that this type of surgery is at the peak of complexity in pediatric cardiac surgery. It requires teamwork for preparation, diagnosis, surgical treatment, and also for postoperative treatment when patient’s condition is extremely severe. Acibadem Sistina Hospital once again confirms that it is a leader in the country and in the region in performing difficult interventions with state-of-the-art equipment just as in developed hospital centers in the world.

“This intervention is performed for complex congenital heart defects such as tricuspid and mitral atresia as well as for complex congenital defects in which biventricular repair is not possible. These patients have pronounced symptoms from their birth, most often with significant cyanosis and congestive heart failure”, says Dr. Chadikovski.

Fontan Procedure is performed when the patient weighs more than 15 kg, i.e. at the age of three or four.

In the present case, the child was first operated when he was 6 months old when a bidirectional Glenn shunt (anastomosis) was performed. It is a palliative surgery performed in infancy. However, one week after the intervention, due to a heart rhythm disorder, a permanent pacemaker was implanted in the child’s abdominal cavity. This so-called Glenn operation is a bridge to the final Fontan procedure.

“Prerequisite for performing a successful Fontan procedure is the performing of diagnostic catheterization of the heart by an interventional pediatric cardiologist in order to measure the exact pressures in the pulmonary circulation which are a very important predictor of the operation’s success. In our patient, two catheterizations were performed for preoperative evaluation, and when it was determined that the pressures were appropriate, surgical repair was initiated. The operation itself was even more complex because the patient’s existing pacemaker had to be replaced with a new one due to its wearing out”, says Dr. Chadikovski.

The operation lasted more than five hours, and the treatment was continued in the Intensive Care Unit for pediatric cardiac surgery patients. What is important is that the next day the patient was disconnected from the ventilation machine and the doctors reduced the patient’s drug treatment to support his heart’s work.

The patient is currently feeling well and slowly preparing to be transferred to the ward with his parent.