title: [Failed transcatheter creation of fenestration in a Fontan patient with original fenestration closed by AngelWings septal occluder: a case report].
abstract: The fenestrated Fontan procedure has helped to reduce the mortality and morbidity of pediatric patients who underwent the Fontan operation. We treated a patient (7-year-old, female) who had developed heart failure 1 year after fenestration closure using an AngelWings device, although the patient met the proposed criteria for test occlusion. Hemodynamic evaluation using the ventricular pressure-area relationship revealed that the patient had both systolic and diastolic dysfunction, which were difficult to recognize by conventional hemodynamic indices. We then tried to percutaneously create a fenestration using a Brockenbrough needle, but this procedure failed. The AngelWings device, which may have been covered by pseudointima (composed of fibroelastic tissue), was hard enough to break the Brockenbrough needle. Re-creating a fenestration after device closure in patients after the fenestrated Fontan operation appears to be difficult, so more accurate methods to predict Fontan physiology after fenestration closure are needed.
authors.affiliation: Department of Pediatric Cardiology, International Medical Center, Saitama Medical University, Saitama.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Ohno
authors.forename: Ishido
authors.initials: I
authors.lastname: Hirotaka
authors.forename: Toshiki
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Asano
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.forename: Hideaki
authors.initials: H
authors.lastname: Senzaki
mesh_terms: D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D002648:Child; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D012086:Reoperation; D016896:Treatment Outcome