title: Percutaneous management of cyanosis in Fontan patients using Amplatzer occluders.
abstract: OBJECTIVE
  To determine causes of cyanosis and to evaluate percutaneous management of cyanosis in a group of consecutive Fontan patients.
  
  
  BACKGROUND
  A variety of communications allow a right-to-left shunt in Fontan circulation causing cyanosis and these communications are amenable to percutaneous closure.
  
  
  METHODS
  Between November 1997 and November 2007, 45 consecutive patients ranging in age from 2.5 to 26 years (median 8 years) with Fontan circulation and cyanosis underwent cardiac catheterization and percutaneous closure of superfluous communications using different types of Amplatzer occluders.
  
  
  RESULTS
  Altogether, 51 communications were detected and 50 of them were closed. In 5 patients (11.1%), multiple communications were present and were closed. Fenestration was detected in 37 of 41 patients (90.2%) after total cavopulmonary connection and all were closed by Amplatzer septal occluders. Five venous collaterals were revealed in 3 of 41 patients (7.3%) with total cavopulmonary anastomosis and were closed by Amplatzer vascular plugs. In 3 patients, lateral tunnel leaks were detected and were closed by Amplatzer PFO occluders. In 4 patients after Kawashima operation, 3 major pulmonary arterio-venous malformations and single venous collateral contributed to the cyanosis and all were closed using Amplatzer vascular plugs.
  
  
  CONCLUSIONS
  Different communications cause cyanosis in Fontan patients. Progressive decline of percutaneous oxygen saturation is suggestive of development of venous collaterals or pulmonary arteriovenous malformations. Superfluous communications are amenable to percutaneous closure using various types of Amplatzer occluders. A novel use of an Amplatzer PFO occluder for the percutaneous closure of a lateral tunnel leak is described.
authors.affiliation: Children's Cardiac Center, University Children's Hospital, Bratislava, Slovakia.
authors.forename: Jozef
authors.initials: J
authors.lastname: Masura
authors.forename: Lucia
authors.initials: L
authors.lastname: Bordacova
authors.forename: Lucia
authors.initials: L
authors.lastname: Borodacova
authors.forename: Peter
authors.initials: P
authors.lastname: Tittel
authors.forename: Pavel
authors.initials: P
authors.lastname: Berden
authors.forename: Tomaz
authors.initials: T
authors.lastname: Podnar
mesh_terms: D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006328:Cardiac Catheterization / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D003326:Coronary Circulation; D003490:Cyanosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004867:Equipment Design; D018729:Fontan Procedure / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D011651:Pulmonary Artery / Q000002:abnormalities / Q000503:physiopathology; D011652:Pulmonary Circulation; D011667:Pulmonary Veins / Q000002:abnormalities / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome