Clipped tube fenestration after extracardiac Fontan allows for simple transcatheter coil occlusion.
BACKGROUND
Expensive devices are increasingly used to close a patent fenestration after a modified Fontan operation. We report our 5-year institutional experience of clipped tube fenestration after extracardiac Fontan operation, which allows for simple transcatheter coil occlusion.


METHODS
We retrospectively reviewed 30 children, median age of 4.0 years (range, 2.4 to 8.8 years) who underwent extracardiac Fontan operation between May 1996 and May 2001, and were fenestrated using a 4- to 8-mm diameter clipped tube graft.


RESULTS
Ten children had a patent fenestration occluded by transcatheter placement of 15 detachable coils (5- to 8-mm diameter). Aortic oxygen saturations increased on average by 5.5% (2% to 14%) and mean pressures in the Fontan circuit by 2.5 mm Hg (0 to 3 mm Hg). Four had immediate complete occlusion angiographically and 6 had trivial residual shunt, but complete occlusion by echocardiography at follow-up. There have been no immediate complications, late coil embolizations, thromboembolic events, or documented hemolysis within a follow-up after coil implantation of 1.7 years (0.4 to 4.5 years). Spontaneous fenestration closure was documented in 8 patients at cardiac catheterization and 9 patients by echocardiography with consistent improvement in resting transcutaneous oxygen saturation. Two children with a patent fenestration have been considered inappropriate for closure, and there was one early surgical death. There have been no complications related to the tube fenestration modification within a follow-up postoperation of 2.6 years (0.1 to 5.5 years).


CONCLUSIONS
Clipped tube fenestration after extracardiac Fontan operation is a useful surgical modification that allows for simple transcatheter coil occlusion.
Bradley
Timothy J
TJ
Cardiac Sciences and Department of Radiology, British Columbia's Children's Hospital, British Columbia, Vancouver, Canada.
Human
Derek G
DG
Culham
J A Gordon
JA
Duncan
Walter J
WJ
Patterson
Michael W H
MW
LeBlanc
Jacques G
JG
Sett
Suvro S
SS
D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D018729:Fontan Procedure / Q000295:instrumentation* / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D012189:Retrospective Studies