Occlusion of Fontan fenestrations using the Amplatzer septal occluder

Abstract

Objective: To evaluate the efficacy and safety of the Amplatzer septal occluder device for occlusion of Fontan fenestrations.

Subjects: Five children aged 5-10 years who had undergone a fenestrated Fontan operation.

Setting: Tertiary paediatric cardiology centre.

Methods: Each patient had right and left heart catheterisation to assess haemodynamic suitability for fenestration closure. Sizing of the defect was achieved with a balloon wedge catheter and transoesphageal echocardiography. Transcatheter occlusion of the fenestration was accomplished using a 4 mm device in three patients, and 5 mm or 9 mm devices in the other two patients. Residual shunting following occlusion was assessed using angiography and echocardiography.

Results: 100% occlusion rate of the fenestration was achieved in all patients. No complications or device failures were seen during the three month follow up period.

Conclusion: The Amplatzer septal occluder device is safe, and effectively occludes the Fontan fenestration.

Figure 1

The Amplatzer septal occluder device.

Figure 2

(A) Angiogram in the right atrium showing the fenestration before closure (arrow). (B) Angiogram in the right atrium showing the device completely occluding the fenestration.