Feasibility and clinical impact of transcatheter closure of interatrial communications after a fenestrated Fontan procedure: medium-term outcomes.
OBJECTIVE
This study was to review an institutional experience with transcatheter closure of Fontan fenestrations and its impact on clinical care.


BACKGROUND
An interatrial fenestration improves postoperative outcomes in high-risk children undergoing a Fontan repair. While technical feasibility has been well defined, the clinical impact of subsequent closure is not well defined.


METHODS
Transcatheter closure of a surgically created or additional interatrial communication was attempted in 152 children at a median interval of 13.8 months after surgery. The clinical records were reviewed for demographic and anatomical characteristics, previous surgeries; catheterization data, and status at latest follow-up.


RESULTS
Mean oxygen saturation and right atrial pressure increased acutely from 87% +/- 5% to 96% +/- 3% (P < 0.001) and 12 +/- 2 mm Hg to 13 +/- 3 mm Hg (P < 0.001), respectively. Higher systemic venous atrial pressures after occlusion correlated with higher pulmonary artery pressures (P = 0.05) before the Fontan procedure and with higher right (P < 0.001) and left atrial (P = 0.001) and ventricular end-diastolic pressures (P < 0.001) immediately before occlusion. Complications included device malposition in 2 children, 1 child each had an air embolism and post-procedural bleeding, and each self-limiting and 1 child had acute ST elevation in inferior ECG leads because of occlusion of the acute marginal branch which was treated with angioplasty and placement of a stent. At follow-up (median 4.5 years), the mean oxygen saturation was 95% +/- 3%. Residual interatrial leaks were noted echocardiographically in 9%. Two children developed protein-losing enteropathy after fenestration closure. No deaths or strokes were observed in follow-up.


CONCLUSIONS
Transcatheter occlusion of Fontan fenestrations is safe with acute and persistent improvements in oxygen saturations.
Pihkala
Jaana
J
Department of Pediatrics, Division of Cardiology, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
Yazaki
Satoshi
S
Mehta
Rohit
R
Lee
Kyong-Jin
KJ
Chaturvedi
Rajiv
R
McCrindle
Brian W
BW
Van Arsdell
Glen
G
Benson
Lee N
LN
D000293:Adolescent; D021721:Balloon Occlusion / Q000295:instrumentation; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003326:Coronary Circulation; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D010100:Oxygen / Q000097:blood; D011474:Prosthesis Design; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014690:Venous Pressure
D010100:Oxygen