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A normal mammal cardiovascular system consists postnatally of a double—pulmonary and systemic—circuit, connected in series, powered by a double pump—the “right” and “left” heart.
Many complex cardiac malformations are characterised by the existence of only one functional ventricle. This “single” ventricle then has to maintain both the systemic and the pulmonary blood circulation, which are not connected in series but in parallel (fig 1A, B). Such a circuit has two major disadvantages: arterial desaturation, both at rest and increasing during exercise, and a chronic volume overload to the single ventricle. Chronic volume overload will in time impair ventricular function, causing from the third decade on a gradual attrition due to congestive heart failure, with few survivors beyond the fourth decade.
In 1971 Francis Fontan1 from Bordeaux, …
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