title: Feasibility and clinical impact of transcatheter closure of interatrial communications after a fenestrated Fontan procedure: medium-term outcomes.
abstract: 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.
authors.affiliation: 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.
authors.forename: Jaana
authors.initials: J
authors.lastname: Pihkala
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yazaki
authors.forename: Rohit
authors.initials: R
authors.lastname: Mehta
authors.forename: Kyong-Jin
authors.initials: KJ
authors.lastname: Lee
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chaturvedi
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Glen
authors.initials: G
authors.lastname: Van Arsdell
authors.forename: Lee N
authors.initials: LN
authors.lastname: Benson
mesh_terms: 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
chemical_list: D010100:Oxygen