[Effects of transcatheter closure of extracardiac Fontan fenestration by Amplatzer duct or septal occluder in three patients]

Abstract

Objective: The purpose of this study was to report our experiences from the transcatheter closure of patent fenestration after total cavopulmonary connection (TCPC) with an extra cardiac conduit.

Methods: Three patients (7, 14 and 8 years old) with various forms of functionally univentricular heart lesions received a total cavopulmonary connection with an extra cardiac conduit as a final reconstructive procedure. Transcatheter occlusion of the fenestration was accomplished using a 8/6 mm Amplatzer duct occluder in one patient, and 5 mm or 10 mm Amplatzer septal occluder in the other two patients. Residual shunting following occlusion was assessed using angiography and echocardiography.

Results: Post total cavopulmonary connection with an extra cardiac conduit, diagnostic catheterization revealed normal pressures in the superior vena cava and pulmonary artery without obstruction at the site of the anastomosis. Angiography of the extra cardiac conduit confirmed the communication between the conduit and the atrium in all three patients and patients still suffered from cyanosis and low oxygen saturation. Immediate full occlusion of fenestration was obtained in all patients. Post closure, mean central venous pressure returned to normal accompanied with significantly increased oxygen saturation. Cyanosis was also significantly attenuated. There were no procedural complications or device failures at intra-hospital and during the 3 to 6 months follow up period.

Conclusions: The Amplatzer septal or duct occluder device is a safe and effective strategy for the Fontan fenestration occlusion.