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Updated: Aug 6, 2026
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Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Unveiling the relationship between Fontan fenestration closure and hemodynamic profile:a single-center study
Michele Lioncino1, Alessandro Felici1, Giulio Calcagni1
1Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children's Hospital, IRCSS, 00146, Rome, Italy; European Reference Network for Low Prevalence and Rare Disease of the Heart- ERN Guard Heart, Italy.
International Journal of Cardiology
|July 24, 2026
Summary
Persistent fenestration after total cavo-pulmonary connection (TCPC) may indicate higher risk in pediatric patients. Pre-Fontan hemodynamics impact fenestration closure, influencing long-term outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Standardizing fenestrated Fontan procedures remains challenging due to varying criteria.
- The prognostic significance of fenestration in total cavo-pulmonary connection (TCPC) requires further elucidation.
Purpose of the Study:
- To assess the prognostic implications of fenestration at baseline and medium-term follow-up in pediatric patients undergoing TCPC.
- To identify predictors of adverse outcomes in this cohort.
Main Methods:
- Retrospective analysis of 109 pediatric patients undergoing extracardiac TCPC (2012-2024).
- Patients stratified by fenestration status (patent, spontaneous closure, transcatheter closure).
- Primary endpoint: composite of cardiovascular death, heart failure hospitalization, functional limitation, symptomatic desaturation, heart transplant listing, or Fontan failure. Analyzed using Cox models and Random Survival Forest (RSF).
Main Results:
- 61% of patients had fenestrated TCPC; 48% had persistent fenestration.
- Persistent fenestration was associated with worse pre-Fontan hemodynamics.
- Univariate analysis linked persistent fenestration, HLHS, and AV regurgitation to adverse outcomes. RSF identified fenestration status as a major predictor.
Conclusions:
- Persistently patent fenestration may serve as a high-risk marker in the Fontan population.
- Pre-Fontan hemodynamic characteristics influence fenestration closure likelihood.
