If your child has been diagnosed with a single-ventricle heart condition, you have likely already navigated more medical decisions than any parent should have to. The Fontan procedure is often the next — and final — step in their surgical journey. Read on to understand what the procedure is, why it is done, what it involves, and why recent advances at Apollo Children's Hospital mean the path ahead may be less difficult than it once was.
Understanding The Procedure
What Is the Fontan Procedure?
The Fontan procedure is a cardiac surgery performed on children born with single-ventricle physiology — a congenital condition in which the heart has only one functional pumping chamber instead of two.
In a normally formed heart, the right ventricle pumps oxygen-poor blood to the lungs, and the left ventricle pumps oxygen-rich blood to the rest of the body. In a single-ventricle heart, both tasks must be managed by one chamber alone — a workload it was never designed to carry. Over time, this places enormous strain on the heart and leads to dangerously low oxygen levels throughout the body.
The Fontan procedure addresses this by rerouting oxygen-poor blood directly to the lungs, completely bypassing the heart. This allows the single ventricle to focus entirely on pumping oxygen-rich blood to the body — significantly reducing its burden and improving the child's circulation.
“The Fontan does not create a normal heart. But it gives a child with a single-ventricle heart a far better chance at a healthier, more active life.”
The Fontan is rarely a standalone procedure. It is typically the third and final stage in a planned series of surgeries, each building on the last:
Stage 1 (in the first weeks of life): A palliative procedure — such as the Norwood operation or a Blalock-Taussig-Thomas shunt — to stabilise blood flow and ensure survival.
Stage 2 (around 4–6 months of age): The Glenn procedure, which connects the superior vena cava directly to the pulmonary artery, partially rerouting blood to the lungs without the heart.
Stage 3 (usually between ages 2 and 5): The Fontan procedure, which completes the rerouting — directing all oxygen-poor blood to the lungs passively, without passing through the heart.
By the time a child reaches the Fontan stage, they and their family have already been through a great deal. Understanding what comes next — and why — can make a significant difference.
Timing And Eligibility
Why Is the Fontan Done, and When?
The Fontan procedure is performed because, without it, children with single-ventricle hearts face a progressive decline. As they grow, the demands on the heart increase. Oxygen saturation drops. The single ventricle weakens. The Fontan is not optional — for eligible children, it is essential to long-term survival and quality of life.
Who Is It For?
The Fontan is recommended for children who have a single functional ventricle and are not candidates for a two-ventricle repair. Common underlying diagnoses include hypoplastic left heart syndrome, tricuspid atresia, and other complex congenital heart defects where biventricular repair is not possible.
When Is the Right Time?
Timing is determined carefully by the cardiac team based on several factors:
The child's age and weight (typically between 2 and 5 years)
Low pulmonary vascular resistance — the pressure in the lung arteries must be low enough for blood to flow passively
Successful completion of Stage 2 (Glenn procedure)
Assessment of cardiac anatomy and haemodynamics through imaging and catheterisation
Proceeding too early or in a child whose lungs are not ready can lead to complications. Your child's cardiac team will assess readiness thoroughly before recommending the Fontan.
A Less Invasive Approach
The Percutaneous Fontan: What It Means for Your Child
Traditionally, the Fontan has been performed as open-heart surgery — requiring a chest incision, cardiopulmonary bypass (the heart-lung machine), general anaesthesia, and a hospital stay of two to three weeks, followed by weeks of restricted activity at home.
While this approach is effective and well-established, it carries the risks and recovery burden of any major open-heart surgery: post-operative pain, risk of infection, prolonged physical and emotional recovery, and significant disruption to the child's daily life.
A Different Approach, Now Available
Apollo Children's Hospital has pioneered a minimally invasive alternative known as the percutaneous Fontan procedure. Instead of opening the chest, the interventional cardiologist uses catheter-based techniques to access the heart through blood vessels — typically through the groin — guided by advanced real-time imaging. No chest incision. No bypass machine.
The difference this makes to a child's recovery is substantial:
Hospital stay reduced from 2–3 weeks to approximately 3 days
Significantly reduced post-operative pain
No chest scar
Lower risk of infection and surgical complications
Faster return to normal activity, including school
Considerably less emotional trauma for the child and family
This is not simply a faster route to the same outcome. The percutaneous approach requires greater imaging precision, meticulous pre-procedural planning, and close coordination between interventional cardiologists, anaesthetists, and imaging specialists. It is an advance in both technique and in the care philosophy — one that places the child's experience at the centre.
“For a child who has already been through two open-heart surgeries, not having to face a third is not a small thing. It is everything.”
In Practice
What This Looked Like for One Child
On August 29, 2022, a six-year-old girl — who had already undergone two open-heart surgeries — became the world's first patient to receive a Fontan procedure without open-heart surgery, at Apollo Children's Hospital, Chennai.
The procedure was performed using catheter-based techniques by Dr. C. S. Muthukumaran and the interventional cardiology team. There were no complications. Three days later, the child was discharged and went home.
The team then monitored her closely for a full year before expanding the programme — a deliberate, cautious approach to ensure the outcomes were durable, not just immediate.
They were. Since that first procedure, 45 children have successfully undergone the percutaneous Fontan at Apollo Children's Hospital. The findings have been published in a leading peer-reviewed cardiology journal and recognised with the Best Paper Award at an international cardiology conference.
For the families of those 45 children, the numbers behind the achievement matter less than what they meant in practice: less time in hospital, less pain for their child, and a faster return to the everyday life that every child deserves.
Why Apollo Children's Hospital
The Expertise Behind the Innovation
The percutaneous Fontan did not emerge in isolation. It was built on a foundation of consistent clinical excellence in paediatric cardiac care — one that Apollo Children's Hospital has developed over many years.
Under the leadership of Dr. C. S. Muthukumaran, the interventional cardiology team has established a track record that places Apollo Children's Hospital among the leading centres for paediatric cardiac care in Asia:
Over 6,500 open-heart surgeries in children
More than 12,000 interventional (keyhole) cardiac procedures
India's largest centre for ductal stenting in low-weight infants
Pioneers of percutaneous pulmonary valve implantation in the paediatric population
Advanced expertise in ventricular septal defect (VSD) device closures
First hospital in the world to perform the Fontan procedure without open-heart surgery
45 percutaneous Fontan procedures completed with consistent, monitored outcomes
These are not credentials collected for their own sake. They reflect a team that has consistently chosen to do more — more innovation, more precision, more care for children whose hearts demand nothing less.
A Note for Families
If your child has been advised to undergo the Fontan procedure, the most important step is a detailed conversation with their cardiac team about which approach is appropriate for them. Not every child will be a candidate for the percutaneous technique, eligibility depends on anatomy, haemodynamics, and the specific findings from their assessment.
What the advances at Apollo Children's Hospital represent, however, is a direction toward procedures that are not only effective, but kinder. Toward a future where more children go through less and come home sooner. If you would like to understand whether the percutaneous Fontan may be an option for your child, the team at Apollo Children's Hospital, Chennai is available for consultation.