Fontan candidacy, optimizing Fontan circulation, and beyond

Feature Editor's Introduction-Experts in congenital heart disease have unified efforts to increase survival and reduce the morbidity of single ventricle patients for decades. Tremendous technical and medical refinements have been instrumental in making it possible for the majority of our single ventricle patients survive postnatal heart surgery and become candidates for the completion of single ventricle palliation. We have long understood that the ultimate success of third-stage single ventricle palliation depends on the early and optimal management of these patients undergoing this not the most technically demanding operation with significant chronic suboptimal physiological state of the circulation. In this issue, Dr d'Udekem ' Udekem and expert colleagues graciously offer a comprehensive review of optimizing Fontan candidacy and the Fontan circulation, including possible interventions beyond Fontan completion. The authors focus on critical circulatory elements from myocardial to atrioventricular valve function and pulmonary arteries that impact the Fontan circulation. They emphasize the proper strategies and proper timing of interventions and provide a further window into innovative approaches proposed to improve the quality of life of patients with a Fontan circulation. Their perspective on this Fontan conundrum is the result of years of research and clinical work. We thank the authors for their outstanding contribution.