Easy technique for emergency fenestration in non-fenestrated Fontan patients

The Fontan procedure is a commonly used final pathway of palliation for single-ventricle physiology. Performing it without fenestration can avoid fenestration-related drawbacks, including subnormal oxygen saturation, decreased exercise tolerance, paradoxical embolization and subsequent need for closure by catheter intervention. If emergency fenestration is required, however, it is not always technically easy to perform, particularly when the atrium is posteriorly located and difficult to expose. We describe an easy technique for creating an anastomosis using a ring-supported polytetrafluoroethylene graft to the atrium for fenestration, performed in 2 patients who underwent extracardiac conduit Fontan procedures without fenestration.