Three-dimensional rotational angiography during percutaneous device closure of fontan fenestration

The Fontan circulation was originally described as palliation for tricuspid atresia but was subsequently used for a wide variety of single-ventricle physiologies, with the common thread being inability to separate the ventricles for independent use in the systemic and pulmonary circulations. Fontan baffle fenestrations have been created since the late 1980s to assist in maintaining the cardiac output in the presence of increased resistance to flow through the pulmonary circuit. Many institutions continue to use an approach to Fontan circulation that utilizes routine fenestration followed by percutaneous device closure at a later time, whereas other institutions use fenestrations sparingly. We present the case of a five-year-old female with hypoplastic left heart syndrome with a fenestrated Fontan, who underwent three-dimensional rotational angiography at the time of catheterization for percutaneous device closure of the fenestration.