Optimal Fenestration of the Fontan Circulation

Zan Ahmad, Lynn H. Jin, Daniel J. Penny, Craig G. Rusin, Charles S. Peskin, Charles Puelz

Research output: Contribution to journalArticlepeer-review


In this paper, we develop a pulsatile compartmental model of the Fontan circulation and use it to explore the effects of a fenestration added to this physiology. A fenestration is a shunt between the systemic and pulmonary veins that is added either at the time of Fontan conversion or at a later time for the treatment of complications. This shunt increases cardiac output and decreases systemic venous pressure. However, these hemodynamic benefits are achieved at the expense of a decrease in the arterial oxygen saturation. The model developed in this paper incorporates fenestration size as a parameter and describes both blood flow and oxygen transport. It is calibrated to clinical data from Fontan patients, and we use it to study the impact of a fenestration on several hemodynamic variables, including systemic oxygen availability, effective oxygen availability, and systemic venous pressure. In certain scenarios corresponding to high-risk Fontan physiology, we demonstrate the existence of a range of fenestration sizes in which the systemic oxygen availability remains relatively constant while the systemic venous pressure decreases.

Original languageEnglish (US)
Article number867995
JournalFrontiers in Physiology
StatePublished - Jun 30 2022


  • Fontan circulation
  • compartmental model
  • fenestration
  • hemodynamics
  • oxygen transport

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)


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