Fontan candidacy, optimizing Fontan circulation, and beyond

Role of Cardiovascular Imaging in the Follow-Up of Patients with Fontan Circulation

“…When discussing the role of multimodality imaging in patients with Fontan circulation, it is necessary to mention that such imaging is fundamental in all the stages before TCPC, guiding clinicians to select good candidates for the Fontan pathway and identifying the right timing for the different steps [ 64 , 65 ]. Indeed, although the Fontan operation has significantly improved the survival in patients with single-ventricle physiologies [ 66 ], long-term morbidity and mortality are still important concerns, and several cardiac and extracardiac complications can occur [ 67 , 68 ].…”

Commentary: Fontan candidacy in which all roads do not lead to Rome

“…Venna and colleagues 1 provide an excellent summary of our current understanding regarding optimizing Fontan completion. The famous “Ten Commandments” 2 related to Fontan completion proposed by Choussat and Fontan himself have, like many great propositions, been tested and refined with time and experience.…”

Commentary: “A new hope” in patients with Fontan circulation: High-risk Fontan operation can be done, but for “perfect Fontan” we still aim

“…A thorough summary of Fontan candidacy and optimization of Fontan circulation was described by Venna and colleagues. 1 They categorized the factors contributing to Fontan indication and late outcomes and proposed a strategy based on the evidence and technologies we currently have. I understood that the authors would like to emphasize the importance of achieving a “perfect Fontan” to be retained as “perfect Fontan circulation” in a lifetime.…”

“…Previous studies focusing on long-term outcomes revealed the issues unique to Fontan circulation, such as Fontan-associated liver disease and stenosis of the Fontan pathway. The study showed that the stenting of a narrowed extracardiac conduit was performed well, 1 and this kind of technology is a field that has been constantly growing. In contrast, there remain many risk factors leading to late complications that are not well understood.…”