BACKGROUND: Surgical fenestrations improve the early postoperative outcomes of the Fontan operation (FO) as a result of reduced systemic venous congestion and increased cardiac output, in spite of mild systemic desaturation and risk of paradoxical embolization. Generally, these fenestrations are occluded in the midterm follow-up. This study was aimed at reporting our experience with the percutaneous occlusion of Fontan fenestrations. METHODS: Longitudinal descriptive, observational, retrospective study of a non-consecutive cohort of patients. The procedure was performed under general anesthesia with the guidance of the transesophageal echocardiogram. A fenestration occlusion test was performed prior to the intervention using a Bermann angiographic catheter. Different techniques and devices were used to occlude fenestrations. RESULTS: From April 2004 to December 2010, 12 patients (mean age 103.1 ± 88.6 months; weight 29.9 ± 12.7 kg) undergoing FO (10 extracardiac conduits, 2 intra-atrial tunnels) were treated 44.1 ± 26.7 months after the operation. One patient failed the balloon occlusion test and the procedure was contraindicated. The following devices were used: HelexTM (4 patients), AmplatzerTM (2 patients), Cardia AtriaseptTM (2 patients), FigullaTM (1 patient), CeraTM (1 patient) and 1 covered Cheatham-PlatinumTM stent. After fenestration closure there was a significant increase in oxygen saturation (82.1 ± 6.5% to 95.2 ± 3.2%), without a significant increase in central venous pressures (12.4 ± 2.6 mmHg to 14.5 ± 2.3 mmHg) or reduction of cardiac output. Immediate residual shunt was observed in 5 patients, which disappeared before discharge. CONCLUSIONS: Percutaneous occlusion of Fontan fenestrations can be performed safely and effectively using a variety of techniques and devices resulting in normalization of systemic saturation levels.
Fontan procedure; Stents; Prostheses and implants; Hearth defects, congenital; Angioplasty
