Transluminally placed endovascular grafts to exclude undesirable intracardiac vascular communications.
OBJECTIVE
In this report, we summarize our early experience using transluminally placed endovascular grafts (TPEG) to close intracardiac communications within surgically created conduits.


METHODS
Three patients with surgically corrected congenital heart disease were treated in this study. All three patients had intracardiac conduits [Modified Fontan (n = 2) or Mustard procedure (n = 1)]. All three patients had intracardiac shunts causing hypoxemia. The shunts were caused by a surgically created fenestration (n =1), a leak at a surgical anastomosis (n = 1) and perforations of a pericardial baffle (n = 1). All three patients were treated percutaneously from venous side approaches. The TPEG devices were constructed of pre-expanded polytetrafluoroethylene (PTFE) sutured to a Palmaz stent.


RESULTS
In the two patients with the modified Fontan procedures, the leaks were completely excluded; in the patient with the Mustard procedure, the perforations in the baffle were not completely excluded. All patients experienced immediate improvements in oxygen saturation ranging from 17Eth 26% (mean, 20.3%). The improvements in oxygen saturation were sustained with values ranging from 12Eth 22% (mean, 17.3%) at the time of clinical follow-up. Clinical follow-up has ranged from 13Eth 19 months (mean, 15 months) and has demonstrated improved exercise tolerance and weight gain. Echocardiographic follow-up has shown no complications of TPEG stenoses, occlusions or migrations. There were no immediate or delayed complications associated with the TPEG devices.


CONCLUSIONS
We report our experience using TPEG devices to exclude intracardiac communications in 3 patients with surgically corrected congenital heart disease. The preliminary results are encouraging and suggest that further investigation in this area should be done.
Quinn
S F
SF
Radiology Associates, P.C., P.O. Box 482, Eugene, OR 97440, USA. squinn@peacehealth.org
Nichols
G M
GM
D000293:Adolescent; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000792:Angiography; D001807:Blood Vessel Prosthesis; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015607:Stents; D016896:Treatment Outcome