Pes planus in children with Fontan circulation

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High prevalence of pes planus in children with Fontan circulation
Lisheng Lin et al
Int J Cardiol Congenit Heart Dis. 2026 Sep 8:25:100711.

 

From ChatGPT:
Fontan circulation is the unique pattern of blood flow created by the Fontan operation, a type of heart surgery used for people born with a single functional ventricle rather than two ventricles capable of pumping effectively.
In a normal heart, the right ventricle pumps oxygen-poor blood from the body to the lungs, while the left ventricle pumps oxygen-rich blood from the lungs to the body. In Fontan circulation, there is no functioning ventricle pumping blood to the lungs. Instead, the major veins returning blood from the body—the superior and inferior vena cava—are connected directly to the pulmonary arteries. Blood therefore flows passively from the veins through the lungs, driven largely by venous pressure and aided by breathing and the pumping action of skeletal muscles.
After passing through the lungs and picking up oxygen, blood returns to the heart through the pulmonary veins. The single functioning ventricle then pumps this oxygenated blood into the systemic circulation. In simplified form:
Body → venae cavae → pulmonary arteries → lungs → left atrium/single-ventricle pathway → single ventricle → aorta → body
A key feature of Fontan physiology is that pulmonary blood flow is passive. This means the circulation generally requires a somewhat higher systemic venous pressure and a low resistance in the pulmonary blood vessels to work effectively. Anything that increases pulmonary vascular resistance can make it harder for blood to pass through the lungs and reduce the amount of blood filling the ventricle.
Fontan circulation can allow people with complex congenital heart conditions—such as tricuspid atresia, pulmonary atresia with an intact ventricular septum, or some forms of hypoplastic left heart syndrome—to survive into adulthood. However, it is not a normal circulation and can cause long-term complications, including reduced exercise capacity, arrhythmias, heart failure, blood clots, protein-losing enteropathy, and Fontan-associated liver disease due partly to chronically elevated venous pressures.
So, the defining concept is: in Fontan circulation, venous blood reaches the lungs without being pumped there by a ventricle; the single ventricle is used primarily to pump blood around the body.