We present our third case of transcatheter Fontan performed at Narayana Health Hospital, Howrah — a rare and technically advanced intervention, unique in the eastern part of India. This case involved the successful use of a single covered stent (Xephyr CS, 69 mm) with in vitro fenestration, approached via the left Glenn pathway.

The patient was an 11-year-old female, weighing 26.5 kg, with a history of Tricuspid Atresia (Type IIB). She had previously undergone bilateral bidirectional Glenn (BD Glenn) shunts with left pulmonary artery (LPA) plasty at the age of one year. Cardiac catheterization performed prior to intervention demonstrated normal pulmonary arterial pressures and pulmonary vascular resistance index (PVRI), confirming suitability for Fontan completion. Notably, she had developed multiple pulmonary arteriovenous malformations (PAVMs) in the right lung, further necessitating this advanced approach.

The procedure was carried out successfully with meticulous planning and execution. The stent placement ensured unobstructed Fontan pathway with effective hemodynamics. Post-procedure recovery was smooth, with extubation on the same day and minimal inotropic support. Importantly, there was no evidence of pleural effusion, a common concern following Fontan completion.

The patient was discharged on the 6th postoperative day, clinically stable, with oxygen saturation of 92% on room air. She was initiated on dual anticoagulation therapy with ecosprin and warfarin for long-term thrombo-prophylaxis.

This case highlights the feasibility and safety of transcatheter Fontan with covered stent and fenestration in select patients, offering a minimally invasive alternative with excellent early outcomes.