Feasibility of combining additional interventions to facilitate hemodynamics during Transcatheter Fontan procedure...

Transcatheter Fontan is an alternative palliation in severely hypoxic univentricular hearts at high-risk for Fontan surgery. While sternotomy, prolonged intubation, and positive-pressure ventilation impede passive systemic venous return, transcatheter Fontan allows early extubation and mobilization to promote inspiratory venous return, additionally aided by the skeletal muscle pump. Following puncture of the pulmonary artery (PA) and atrium through the transverse pericardial sinus, a long-covered stent bridges the inferior vena cava to the PA. Concurrent interventions create wide inter-atrial communication, interrupt competitive aortopulmonary or antegrade flows, and relieve PA stenosis. This case series details such interventions to facilitate optimal hemodynamics after establishing neo-Fontan circulation.