{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:09:22Z","timestamp":1775779762394,"version":"3.50.1"},"reference-count":29,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"unspecified","delay-in-days":148,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,11,5]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with single-ventricle physiology are often palliated with the Fontan operation, which may involve the creation of a fenestration. We aimed to evaluate differences in cardiopulmonary exercise test (CPET) performance between patients with fenestrated and non-fenestrated Fontan circulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patients with a Fontan circulation referred to CPET between 2006 and 2024 were included and were categorised based on their fenestration status at the time of CPET. Logistic regression analyses were performed to assess the impact of fenestration on peak oxygen consumption (VO\n                      <jats:sub>2<\/jats:sub>\n                      ), and Cox proportional hazard to evaluate the impact of fenestration on cardiovascular outcomes (death, heart transplant and Fontan-related hospitalisation).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 184 patients, 141 were classified as non-fenestrated and 43 as fenestrated. The minute ventilation-carbon dioxide production (V\n                      <jats:sub>E<\/jats:sub>\n                      \/VCO\n                      <jats:sub>2<\/jats:sub>\n                      slope) was higher in the fenestrated (36.9\u00b17.9) versus (33.2\u00b16.2; p=0.009) in the non-fenestrated group. There was no significant difference in predicted VO\n                      <jats:sub>2<\/jats:sub>\n                      between groups (non-fenestrated 51.9%\u00b114.4 vs 51.3%\u00b115.6; p=0.7). Resting oxygen saturation was higher in the non-fenestrated group (93%\u00b14.7 compared with fenestrated group 90.1%\u00b15; p&lt;0.001). Fontan fenestration was not significantly associated with the composite outcome; older patient age at the time of the CPET, cirrhosis and ventricular ejection fraction &lt;40% were significantly associated with higher risk, while higher resting systolic blood pressure, left ventricular morphology and higher predicted peak VO\n                      <jats:sub>2<\/jats:sub>\n                      were protective.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The increased hypoxia and reduced ventilatory efficiency associated with Fontan fenestration offset any potential benefits, resulting in similar exercise performance between the groups. Fontan fenestration was not significantly associated with cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003639","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T05:05:39Z","timestamp":1764306339000},"page":"e003639","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiopulmonary exercise test variations in patients with a Fontan circulation: impact of fenestration patency and associations with clinical outcomes"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8412-7445","authenticated-orcid":false,"given":"Laura M.","family":"Ortega-Aviles","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian D.","family":"Santos-Patarroyo","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek N.","family":"Opp","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, The Children\u2019s Heart Clinic, Children\u2019s Minnesota - Minneapolis, Minneapolis, Minnesota, USA"},{"name":"Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Cetta","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA"},{"name":"Department of Pediatrics, Division of Cardiology, University of Chicago Charter School, Chicago, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander C.","family":"Egbe","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8864-8474","authenticated-orcid":false,"given":"William R","family":"Miranda","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas G","family":"Allison","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA"},{"name":"Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"2025112721051576000_12.2.e003639.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000696"},{"key":"2025112721051576000_12.2.e003639.2","doi-asserted-by":"publisher","DOI":"10.1136\/thx.26.3.240"},{"key":"2025112721051576000_12.2.e003639.3","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.82.5.1681"},{"key":"2025112721051576000_12.2.e003639.4","doi-asserted-by":"publisher","DOI":"10.1161\/hc0202.102237"},{"key":"2025112721051576000_12.2.e003639.5","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(94)91924-0"},{"key":"2025112721051576000_12.2.e003639.6","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2022.915045","article-title":"Impact on clinical outcomes from transcatheter closure of the Fontan fenestration: A systematic review and meta-analysis","volume":"10","author":"Greenleaf","year":"2022","journal-title":"Front 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associated haemodynamics and prognosis","volume":"21","author":"Miranda","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2025112721051576000_12.2.e003639.16","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1001\/jamacardio.2019.5459","article-title":"Diastolic Heart Failure in Patients With the Fontan Circulation: A Review","volume":"5","author":"Budts","year":"2020","journal-title":"JAMA Cardiol"},{"key":"2025112721051576000_12.2.e003639.17","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1093\/ejcts\/ezab298","article-title":"Persisting and reoccurring cyanosis after Fontan operation is associated with increased late mortality","volume":"61","author":"Schafstedde","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025112721051576000_12.2.e003639.18","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1111\/chd.12451","article-title":"Effects of persistent Fontan fenestration patency on cardiopulmonary exercise testing variables","volume":"12","author":"Heal","year":"2017","journal-title":"Congenit Heart Dis"},{"key":"2025112721051576000_12.2.e003639.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.12.063"},{"key":"2025112721051576000_12.2.e003639.20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-0803.2008.00199.x"},{"key":"2025112721051576000_12.2.e003639.21","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq356"},{"key":"2025112721051576000_12.2.e003639.22","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1093\/eurjpc\/zwae031","article-title":"Morbidity and mortality in adults with a Fontan circulation beyond the fourth decade of life","volume":"31","author":"Constantine","year":"2024","journal-title":"Eur J Prev Cardiol"},{"key":"2025112721051576000_12.2.e003639.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.03.582"},{"key":"2025112721051576000_12.2.e003639.24","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-312807"},{"key":"2025112721051576000_12.2.e003639.25","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.026087","article-title":"Impact of Fontan Fenestration on Long-Term Outcomes: A Propensity Score-Matched Analysis","volume":"11","author":"Daley","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2025112721051576000_12.2.e003639.26","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1007\/s00380-021-01798-y","article-title":"Optimal criteria for transcatheter closure of Fontan fenestration: a single-center experience with a review of literature","volume":"36","author":"Kawasaki","year":"2021","journal-title":"Heart Vessels"},{"key":"2025112721051576000_12.2.e003639.27","first-page":"1358","article-title":"Clinical Outcomes of Percutaneous 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Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2025-003639","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T05:05:41Z","timestamp":1764306341000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2025-003639"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,11,27]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/openhrt-2025-003639"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2025-003639","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}