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The World Loses Another Giant in Pediatric Heart Surgery

Dr. Francis Fontan

When receiving the news that Dr. Francis Fontan passed away earlier this week, Dr. Novick’s initial response was “Another giant in pediatric heart surgery passed from our midst.” Dr. Fontan is the individual who pioneered the development of the “Fontan” operation. The Fontan operation made it possible for those children born with one ventricle to have a chance to separate the “red” from the “blue” blood and lead nearly normal lives for many years. Dr Fontan’s contribution to the field of pediatric heart surgery cannot be over-emphasized as it is the final operation which nearly all children born with one ventricle receive thus providing them with a future free of the debilitating effects of chronic cyanosis.

Fontan Procedure

 

Dr. Novick reminisced about meeting Dr. Fontan.

“As a resident in cardio-thoracic surgery at the University of Alabama from 1987-1991 I was fortunate to meet Dr. Fontan on more than one occasion because of his professional and personal relationships with Dr. John W. Kirklin and Albert D. Pacifico. I will never forget my first encounter with Dr. Fontan. He was visiting Birmingham to work on the finishing touches of his sentinel paper with Dr. Kirklin, “The Perfect Fontan”. On the day I had the honor of meeting him I was assigned by Dr. Pacifico to start the second case of the day. As would have it, by design I am sure, it was a child who needed a completion “Fontan.”

As usual this required a redo-sternotomy, which we performed without difficulty. When I sent word to Dr. Pacifico that the sternum was open, I received an unusual response, “Proceed”, which meant he wanted me to lyse the adhesions and place the cannulation sutures to enable the patient to be placed on bypass. I knew that Dr. Fontan was in the hospital and might be visiting the operating rooms, so I was a bit nervous. Nonetheless we proceeded without incident. When I sent word again to Dr. Pacifico that we were ready for him to cannulate and place the patient on bypass, I was again greeted with “Proceed.” This response was totally unexpected as I had never placed a “Fontan” completion patient on bypass, and I was early in my residency. So, as I was placing the arterial cannula, Dr Fontan suddenly appears above the anesthesia screen and says ‘Good morning Dr. Novick!’ Well as fate would have it, I muffed the cannulation and could not get the arterial cannula in. I stopped and responded ‘Good morning Dr. Fontan, sorry I muffed the cannulation, could you please ask Dr. Pacifico to come now.’ Francis laughed and apologized for spooking me at exactly the time I had tried to place the aortic cannula. Remembering this encounter with Dr. Fontan reminds me of the importance of having a sense of humor even while performing challenging heart surgery.”

Francis Fontan, creator of the Fontan operation, actually considered his greatest accomplishment the formation of the European Association of Cardio-thoracic Surgery. He is truly an innovative leader in pediatric cardiac surgery and one of the main individuals responsible for the progress of cardiac surgery in Europe. The world will miss Francis, but we can never forget his tremendous contributions to the field of cardiac surgery, specifically pediatric cardiac surgery. His legacy to this world can be found in the thousands of adults living with Fontan circulation today. We imagine that he and Dr. John Kirklin are together now, perhaps discussing “The Perfect Fontan.”

Perspective from a Perfusion Student

Brooke managing the bypass machine in Kharkiv

Brooke Tracy, a perfusion student from the US, recently joined our team on a trip to Kharkiv, Ukraine. She describes her experience as a student on her first medical mission trip.

“There are no words to describe how amazing and influential my first mission trip with the Novick Cardiac Alliance was, but I can say with absolute certainty I would recommend it to anyone! Not only was the team amazing and so well versed in healthcare skills, but they also were some of the most empathetic and passionate people I have had the opportunity to work alongside. Not to mention the local Ukrainian team. They all were very excited to learn from NCA in ways to improve their practice, and they were incredibly welcoming and appreciative of all that NCA has done for their hospital system.

As a perfusion student, I didn’t really know what to expect as our field is pretty dependent upon technology and supplies. I had done some research on the Ukrainian healthcare system, but was vastly underprepared when it came to fully understanding the difficulties in which the local team has in acquiring, what in our practice, is simple equipment. But the lack of equipment never stumped the local perfusionist. Alex and Olga were some of the most innovative perfusionists I’d ever met. In order to make the most of each piece of equipment, their circuit design and construction was innovative. Both were incredibly knowledgeable, but it was humbling to see how much they each were looking to learn more and grow in their practice.”

NCA Perfusionists John and Brooke working alongside Kharkiv perfusionists Alex and Olga

What she gained as a student: 

“In the end, the most inspiring thing about this trip for me was to see the passion and moral of the local team. The nurses were so compassionate and went out of their way to comfort their patients. They really did an amazing job, especially those that were medical students working night shift to gain experience! You could tell that this hospital served their local community in more than just physical care, as the empathy was overflowing with every patient. The parents were allowed back in the ICU with their children post-op and it made a world of difference in the recovery of our patients.

After returning from this trip, not only had I gained a ton of knowledge and skills from both the NCA team and the local team, but I also had a better appreciation for all of the resources that we have at our disposal in the US. I have developed some new practices and little tricks that make my perfusion practice more resourceful and limit my medical waste since returning from the mission.

Brooke with patient Sofia, who had 60 minutes on bypass during her operation.

I can not only recommend missions to anyone in the field, but especially to students because I feel that it gives you a advantage to being a resourceful, motivated, and passionate perfusionist, which is exactly what this world needs more of.”

-Brooke Tracy, Perfusion Student, South Carolina, USA