Left ventricular diastolic dysfunction is associated with poor prognosis in patients with hypertrophic cardiomyopathy and CHD. We report the case of an infant concomitant with hypertrophic cardiomyopathy, an atrial septal defect, and left ventricular diastolic dysfunction, who was successfully managed with fenestrated closure of the atrial septal defect.

An ostium secundum atrial septal defect (ASD) is a CHD that can be treated percutaneously since 1974, mostly cases with only one main defect. In cases with fenestrations close to the main defect, a single occluder can be used for treatment because the discs extend beyond the waist of the device. In some cases where the defects are far from each other, they may require either more than one device or surgical closure. We present two patients in whom we observed fenestrations far from the primary defect. Initially, the main ASDs were closed with an ASD occluder, and then the fenestrations were closed with a patent ductus arteriosus (PDA) coil, resulting in complete closure of both defects. This shows that closing small fenestrations that are far away from the primary interatrial defect without rims and using other devices instead, such as a PDA coil, is feasible and can avoid the need for an open-heart surgical procedure; moreover, it is important to note that leaving these fenestrations open can have the same physiology as a patent foramen oval.

We report a case of an alternative transcatheter use of the modified Medtronic microvascular plug to modify fenestration stent flow in a patient with a rapidly deteriorating clinical condition. This four-year-old boy developed severe cyanosis following fenestration stent insertion, initially placed due to prolonged drainage post-Fontan with extra-cardiac conduit. In April 2023, he underwent urgent cardiac catheterisation and had partial occlusion of fenestration stent with a modified 9Q microvascular plug. His oxygen saturations improved from 50 to 89% in room air with no re-emergence of raised cavopulmonary pressures.

Transcatheter creation of an interatrial communication using the Occlutech Atrial Flow Regulator Device for pulmonary hypertension or heart failure is well described. We report a case of an 8-year-old boy with a failing Fontan circulation, in whom the Atrial Flow Regulator was used to successfully create a fenestration between the pulmonary artery and left atrium, improving his clinical condition.

A new approach was used in the percutaneous treatment of two patients with severe recoarctation involving the origin of the left subclavian artery. A tiny handmade fenestration was created in a NuMED-covered Cheatham-platinum stent before its implantation to avoid left subclavian artery occlusion. The stent placement was performed using a two-guidewire technique in which the different stiffness helped a proper positioning of the stent. After the stent deployment, the fenestration was enlarged performing a balloon angioplasty to improve flow in left subclavian artery.

Objective: The use of covered stents to close fenestration in total cavopulmonary connection is presented. Methods: We retrospectively reviewed data of all patients undergoing the procedure of a covered stent to close fenestration of total cavopulmonary connection between 2005 and 2012. Results: A total of 50 patients met the inclusion criteria. Median age and weight were 7.7 years and 20 kg, respectively. Median interval between Fontan completion and fenestration closure was 13 months. The femoral vein was used in 42 patients and the jugular vein in eight patients. Of the patients, seven received two stents. Covered stents were CP stents in 42 patients and Atrium Advanta V12 in eight patients. BIB balloons were used in 24 patients and simple balloons in 18 patients. Simultaneous occlusion of venous collaterals was observed in five patients. Median procedural and fluoroscopy times were 49 and 8 minutes, respectively. Mean central venous pressure rose from 10 to 12 mmHg. Mean oxygen saturation increased from 88% to 96%. Full occlusion was confirmed in 47 patients. The remaining had residual shunts: two patients had intracardiac Fontan, and one patient had a stent that could not be fully opened. Following the procedure, five patients had local bleeding, and three delayed discharge 48 hours after the procedure. There was no thromboembolic event after a mean follow-up of 49 months. Conclusion: Covered stent is a good option to close fenestration in extracardiac total cavopulmonary connection. It is safe, easily achievable with low fluoroscopy time, with very low risk of complication or failure. Good results are sustainable when excluding patients with none circular pathway.

In November 1943, one of Barbara Hepworth’s daughters (Sarah, one of triplets) developed osteomyelitis of the thigh. This necessitated operation and subsequent treatment at the Princess Elizabeth Orthopaedic Centre in Exeter by Mr. Norman Capener. Artist and surgeon subsequently became friends and she encouraged his activities as a ‘weekend sculptor’. At his invitation she came to the hospital in November 1947 watching him in out-patients but more particularly in the operating theatre; other visits to London and Exeter followed. These studies of orthopaedic procedures form the great majority of Hepworth’s sixty-plus hospital drawings/paintings but there is also a small group of six paintings involving an operation on the ear made in April and May 1948. The link between these two and the introduction to the ear surgeon, Mr Garnett Passe, is unclear.

Five of the paintings of the ear operation are still in circulation but there is also a sketchbook containing no fewer than 28 drawings. A selection of the sketches together with the fenestration series of paintings will be discussed and also the relationship with the surgeon, Mr Garnett Passe.

Segmental duplications (also termed ‘fenestrations’) of the fetal anterior cerebral artery are a relatively rare anomaly. Their occurrence was studied in 200 fetuses at 20–40 wk gestational age. Duplications were found in 21 of the 200 fetuses, i.e. 10.5%. In 2 fetuses, i.e. 1%, the duplications were bilateral. In 1 case, i.e. 0.5%, 2 duplications were found on the left anterior cerebral artery. There were 15 segmental duplications on the left anterior cerebral artery, i.e. 62.5% of all duplications, and 9 on the right, i.e. 37.5%. The duplications were located in the distal part of the A1 segment in 45.7%, at the level of the anterior communicating artery (A1–A2) in 37.7%, and in the initial part of the A2 segment in 16.6%. The duplications had 4 different forms namely oviform, fissured, triangular and punctate.