Surgical preconditioning and completion of total cavopulmonary connection by interventional cardiac catheterisation: a new concept.
A new, staged procedure for univentricular repair of "high risk" patients using a combined surgical transcatheter technique is reported. As first step a surgical hemifontan procedure was performed and a multifenestrated patch inserted into the right atrium. For later transcatheter completion of univentricular repair, a subtotal banding just above the cavoatrial junction was performed. Two months later transcatheter completion was performed by balloon dilatation of the banded cavo-atrial junction and additionally either by inserting a covered stent as intracardiac conduit between the superior and inferior vena cava or by inserting a (non-covered) stent into the cavo-atrial junction and occluding the fenestrations in the right atrial patch using Rashkind-PDA occluders. This new technique was successfully applied without mortality in eight patients with a preoperative mean pulmonary pressure of 18 to 23 mm Hg. No complications typical for Fontan-like corrections occurred within the follow up period of 4 to 14 months.
Hausdorf
G
G
Charité, Department of Paediatric Cardiology, Berlin, Germany.
Schneider
M
M
Konertz
W
W
D000293:Adolescent; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D018729:Fontan Procedure; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles; D006801:Humans