Determinants and clinical significance of flow via the fenestration in the Fontan pathway: A multimodality study

Status of Systemic to Pulmonary Arterial Collateral Flow After the Fontan Procedure

“…14 In contrast, in our paired cohort, on average 6 months out from Fontan surgery, fenestration flow only accounted for 11% of aortic flow, and only 2 of 27 patients with fenestrations had flow reversal in the Fontan baffle. Despite our group being closer to surgery, the groups had similar age at time of exam and fenestration sizes were comparable (all 4 mm in our group, range of 3–6 mm, average 4.2 mm in the Grosse-Wortmann study).…”

Model-Based Comparison of the Normal and Fontan Circulatory Systems—Part II

“…min (0.9 L/min/m 2 ), sufficient to raise the Qp/Qs to no higher than 1.2 or 1.5 (fenestration present or absent, respectively), is the maximum that could be tolerated without the action of compensatory mechanisms. Collateral flow estimates in the literature range from 1.3 L/min/m2 for 4-year-old Fontan patients 18 to 0.62 L/min/m 2 for adult Fontan patients 21 Finally, our computational model shows the major effect of end-diastolic elastance. Factors such as age 22,23 and physical activity 22 have an effect on end-diastolic stiffness in other settings and remain to be explored in the Fontan circulatory arrangement.…”

Magnetic Resonance Imaging as a Decision-Making Tool in Congenital Heart Disease Surgery

“…[18][19][20] Our recent PCMRI study in patients with a fenestration showed that most or all of the inferior vena caval flow was diverted into the pulmonary venous atrium through the fenestration in most patients. 21 In some patients, even some of the superior vena caval flow was diverted into the pulmonary venous atrium, further reducing the blood flow to the pulmonary arteries as demonstrated in this patient. This patient with double-inlet left ventricle with transposition of the great arteries and aortic arch hypoplasia underwent Norwood procedure followed by bidirectional cavopulmonary shunt in infancy and fenestrated Fontan procedure at 2 years of age.…”