Fontan Fenestration: To do or not to do?

Leaving a fenestration in the interatrial septum during a Fontan repair is useful in relieving the central venous congestion when pulmonary blood flow is driven by venous pressure in Fontan repair. Data from a multicenter Pediatric Heart Network has been published in JACC: Advances [1]. Subjects were between 2-6 years at Fontan surgery done between 2010 and 2020 with cardiac catheterization done within 1 year prior to the surgery. Fenestration was done in 465 of the 702 patients. Interestingly placement of fenestration was associated with center and Fontan type – whether it was lateral tunnel or extra cardiac. Shorter length of hospital stay after Fontan repair was noted in those who received a fenestration. They noted that benefit was more pronounced if mean pulmonary arterial pressure was 13 mm Hg or more, as expected. An accompanying editorial discussed the matter further [2]. They noted the bias between centers and the type of operation, whether it was a lateral tunnel or extra cardiac conduit. Doing a fenestration during lateral tunnel type of repair was quite easy while doing it during extra cardiac conduit placement was ‘annoying’. During an extra cardiac conduit placement, placing a fenestration would mean aortic cross clamping and stopping the heart for placing a fenestration. This is reflected by the observation that while 96% of lateral tunnel cases received a fenestration while only half of the extra cardiac conduit cases received a fenestration....
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiac Surgery General Cardiology Source Type: blogs