Extracardiac Fontan Operation with Prebuilt Fenestration: Preparing the Road for Future Atrial Access

The extracardiac Fontan procedure is the most widely adopted surgical approach for definitive palliation of single-ventricle anomalies, offering improved hemodynamics and reduced arrhythmogenic risk. However, limited access to the pulmonary venous atrium during follow-up poses significant challenges for electrophysiologic and interventional procedures. We describe a simple technical modification of the extracardiac Fontan designed to preserve these advantages while facilitating future percutaneous access.