{"id":62781,"date":"2024-02-24T08:56:47","date_gmt":"2024-02-24T03:26:47","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=62781"},"modified":"2024-02-24T09:57:00","modified_gmt":"2024-02-24T04:27:00","slug":"fontan-fenestration-to-do-or-not-to-do","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/fontan-fenestration-to-do-or-not-to-do\/","title":{"rendered":"Fontan Fenestration: To do or not to do?"},"content":{"rendered":"<p><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/2VMbucXlqmg?si=wmD7CjmDz-xDcEqg\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>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 <em>JACC: Advances<\/em> [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 &#8211; 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.<\/p>\n<p>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 &#8216;annoying&#8217;. 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. Authors of the editorial also noted that the cutoff of 13 mm Hg mean pulmonary artery pressure could not be taken as a great value, knowing how much venous pressure can vary with the level of hydration during cardiac catheterization. In their opinion, all patients would benefit from a fenestration, though it was technically more difficult to do it while doing an extracardiac conduit type of Fontan repair.<\/p>\n<p><strong><span style=\"color: #0000ff;\">References<\/span><\/strong><\/p>\n<ol>\n<li>Garick D. Hill, Danny T.Y. Wu, M. Eric Ferguson, Saul Flores, Salil Ginde, Kevin D. Hill, Michael Johansen, Jane W. Newburger, Zhiqian Gao, and James F. Cnota. <a href=\"https:\/\/www.jacc.org\/doi\/10.1016\/j.jacadv.2024.100846\">Preoperative Hemodynamics Impact the Benefit of Fenestration on Fontan Postoperative Length of Stay<\/a>. JACC Adv. 2024 Mar, 3 (3) 100846.<\/li>\n<li>Yves d&#8217;Udekem and Alyssia Venna. <a href=\"https:\/\/www.jacc.org\/doi\/10.1016\/j.jacadv.2024.100844\">The Annoying Act of Creating a Fenestration<\/a>.\n<div class=\"epub-section\"><span class=\"epub-section__item\"><a class=\"epub-section__title\" href=\"https:\/\/www.jacc.org\/journal\/jacc-advances\">JACC Adv<\/a><\/span>.\u00a0<span class=\"epub-section__item\"><span class=\"epub-section__date\">2024 Mar<\/span><\/span>, 3 (3) 100844.<\/div>\n<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":62784,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[22,9],"tags":[],"class_list":["post-62781","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cardiac-surgery","category-general"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Fontan Fenestration: To do or not to do? - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/fontan-fenestration-to-do-or-not-to-do\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Fontan Fenestration: To do or not to do? - All About Cardiovascular System and Disorders\" \/>\n<meta property=\"og:description\" content=\"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. 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