Peter Laussen — 50 Years of Fontan, and What Comes Next

In the second episode of our Fontan at 50 short season with @PCICS, Dr. Peter Laussen (Boston Children's Hospital) joins Greg and Deanna Tzanetos for the long view on how the Fontan evolved and where it's heading next. Peter traces the procedural arc — atriopulmonary, lateral tunnel, fenestration, extracardiac conduit — and the physiology behind each shift: PAs in continuity, early staging of the pulmonary connection, setting the circulation up for passive flow. He covers the ICU preparation that still holds today, and why pushing the Fontan to younger ages stalled on an immature pulmonary vascular bed. The conversation then turns forward. MRI-derived flow vectors and tailored anastomoses as the new standard. The adult Fontan problem, and why community EDs get into trouble applying a two-ventricle lens. "My Heart," a patient-carried app in development at Boston to help close that gap. And the most exciting shift of the last decade — staged myocardial growth for borderline left hearts, aiming at a two-ventricle endpoint instead of Fontan. Peter closes with a challenge to the field: PCICS at the centre of a learning ecosystem that captures not just our actions, but our decisions. Produced in collaboration with @PCICS.