Regression of pulmonary arteriovenous malformations after transcatheter reconnection of the pulmonary arteries in patients with unidirectional Fontan.
OBJECTIVE
Pulmonary arteriovenous malformations (PAVM) develop in patients with a lung deprived of hepatic blood flow. Unidirectional Fontan patients have superior vena cava (SVC) blood directed to the left or right pulmonary artery (PA), and inferior vena cava (IVC) and hepatic blood baffled to the contra-lateral PA. Cyanosis often develops due to PAVM in the lung deprived of hepatic blood. We report experiences with transcatheter PA reconnection in patients with unidirectional Fontan and PAVM.


METHODS
Patients with unidirectional Fontan, cyanosis, and PAVM underwent transcatheter PA reconnection. Following simultaneous injection of contrast into PAs, a transseptal needle was used to puncture from one PA to the other. A balloon-mounted, uncovered stent was positioned bridging the pulmonary arteries. The procedure provided a nonrestrictive, permanent communication between the PAs. Results were retrospectively reviewed. Catheterization data and oxygen saturations before and after procedure were analyzed.


RESULTS
Six patients with a median age of 14 years (range 13-35 years) were identified. All patients had functional single ventricle with unidirectional Fontan and PAVM in the lung supplied solely by SVC flow. The reconnection procedure was performed successfully without complications in all cases. The median follow-up time for all 6 patients was 12.8 months (range 5.8-19.3 months). Median oxygen saturation was 0.86 (range 0.81-0.92) prior to the procedure, and 0.95 (range 0.92-0.98) on follow-up, with a median increase of 9% (range 8-11%).


CONCLUSIONS
Patients with unidirectional Fontan and PAVM demonstrate increased oxygen saturations following reconnection of PAs, suggesting regression of PAVM. This procedure can be performed safely using uncovered stents, and it is effective in improving systemic oxygen saturations.
AboulHosn
Jamil
J
Ahmanson/UCLA Adult Congenital Heart Disease Center at UCLA-Cardiology, Los Angeles, CA 90007, USA. jaboulho@yahoo.com
Danon
Saar
S
Levi
Daniel
D
Castellon
Yelba
Y
Child
John
J
Moore
John
J
D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006328:Cardiac Catheterization; D002932:Cineangiography; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010100:Oxygen / Q000097:blood; D011651:Pulmonary Artery / Q000002:abnormalities*; D011667:Pulmonary Veins / Q000002:abnormalities*; D012074:Remission Induction; D015607:Stents; D016896:Treatment Outcome
D003287:Contrast Media; D010100:Oxygen