Dilatation and stenting of the fontan pathway: impact of the stenosis treatment on chronic ascites.
OBJECTIVE
Low pulmonary artery pressure (PAP) and unobstructed flow in the pulmonary arteries (PA) and the systemic veins are the most important factors for optimal long-term Fontan hemodynamics. We retrospectively analyzed the impact of transcatheter interventions for treatment of stenoses in the Fontan pathway to optimize the circulation, with special attention to chronic ascites.


METHODS
Sixty-three of a total of 112 patients underwent heart catheterization 4.6 (1.0-11.4) years after Fontan operation. The median age of the patients at the end of follow-up was 11 (3.1-45) years. Patients were divided into two groups, one with chronic ascites and one without. The impact of elevated PAP and of morphologic stenoses in the Fontan pathway for the development of chronic ascites was analyzed.


RESULTS
Ascites was observed in 11 patients; 5 of them had stenosis in the Fontan pathway (P = 0.010). High PAP of 15 mmHg or more (n = 13) was correlated positively with the development of ascites (5 of 13, P = 0.040). Twenty interventions for removal of stenosis in the Fontan pathway were performed in 14 patients. We observed temporary relief of ascites in all and complete resolution of ascites after alleviation of the stenosis in 2 patients with PAP <12 mmHg.


CONCLUSIONS
Transcatheter treatment of stenosis can effectively improve the hemodynamics in Fontan circulation, even in patients without measurable pressure gradient. In those with low PAP, it may lead to the disappearance of chronic ascites.
Ovroutski
Stanislav
S
Department of Congenital Heart Diseases, Deutches Herzzentrum Berlin, Berlin, Germany. ovroutski@dhzb.de
Ewert
Peter
P
Alexi-Meskishvili
Vladimir
V
Peters
Bjorn
B
Hetzer
Roland
R
Berger
Felix
F
D000293:Adolescent; D000328:Adult; D001201:Ascites; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003326:Coronary Circulation; D005260:Female; D018729:Fontan Procedure; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000473:pathology* / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome