Percutaneous transcatheter communication between the pulmonary artery and atrium following an extra-cardiac Fontan

In a nonfenestrated modified Fontan, transcatheter creation of a fenestration presents technical difficulties, especially with the extra-cardiac modification where a Gore-Tex tube is placed between the inferior caval vein and the pulmonary arteries. The authors describe an alternative approach to perforating the Gore-Tex tube to create a fenestration by making a communication between the pulmonary artery and the atrial chamber, thus bridging the two circulations through native tissue. © 2008 Wiley-Liss, Inc.