Mental Health in Children and Adolescents with Fontan Circulation

All articles of this category (opens in new window) Background: Individuals with complex congenital heart disease are at increased risk of mental health conditions. We aimed to investigate mental health in a contemporary cohort of Fontan patients. Methods: Single-ventricle patients after staged univentricular palliation born between 2006 and 2019 were identified. Children and adolescents with neurodevelopmental assessment performed between June 2017 and May 2025 were eligible for inclusion. Parents completed at least one of two validated screening questionnaires for psychopathology (Strengths and Difficulties Questionnaire, SDQ P4–17; Child Behavior Checklist, CBCL 6–18R). Rates and areas of psychological concerns were determined and compared with normative data. Demographic, surgical, and perioperative data of staged univentricular palliation were collected to evaluate potential risk factors for mental health problems. Results: A total of 114 patients (77 males/37 females) were assessed at 8.8 (IQR: 5.3–11.8) years of age. The SDQ ( n = 103) revealed psychological concerns in 39% of patients, twice the proportion reported in the representative German Child and Adolescent Health Survey. Emotional symptoms were the most prevalent (41.7%). Girls showed a higher prevalence of prosocial behaviors ( p = 0.017), while boys exhibited more hyperactivity symptoms ( p = 0.032). The CBCL was completed for 74 school-aged patients. Abnormal scores were reported for 59.5% of patients. Internalizing problems (55%) were more frequent than externalizing problems (20%). Overall, psychological concerns were observed in 50% of the patients. Mental health problems tended to be more common in hypoplastic left heart syndrome compared with other single ventricle lesions (66.7% vs. 47.4%, p = 0.058). Three factors were independently associated with poorer mental health outcomes: duration of hospital stay after the first palliative step (OR: 1.021, CI: 1.006–1.037, p = 0.007), oxygen saturation (OR: 1.145, CI: 1.027–1.276, p = 0.015) and age at assessment (OR: 1.179, CI: 1.048–1.326, p = 0.006). Conclusion: The considerable psychological burden in children and adolescents emphasizes the importance of incorporating regular mental health assessments into routine follow-up care for patients with univentricular heart disease. Mental health problems became more prevalent with increasing age, underscoring the need for repeated assessments. Further research is required to develop evidence-based strategies that support the resilience of young Fontan patients. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany