LAUSR

Graphical Abstract A framework for depicting the factors that in fl uence outcomes in the Fontan circulation. Four domains of Fontan-associated challenges are proposed: (i) systemic fi brogenesis; (ii) lymphatic insuf fi ciency; (iii) sarcopenia and exercise; and (iv) behaviour and mental health. Fontan circulation haemodynamics underlie all of these domains; however, additional factors probably in fl uence these outcomes including: (i) variability in foetal organ development impacting substrate presenting for care at birth; (ii) social factors; (iii) genetic in fl u-ences on stressors as either promoting complication or providing resilience; and (iv) potential injury accrued during the course of medical and surgical treatment.