[Pulsatile Fontan: transcatheter closure of patent pulmonary artery. Follow up mid-term].
OBJECTIVE
We report the percutaneous closure of the pulmonary artery with residual shunt in patients with Fontan type circuit.


METHODS
Patients aged 9 and 11 years, with SaO2 of 88 and 96%, respectively. One of them coursing with headaches and functional class II. Both patients with total cavopulmonary anastomosis and fenestrated extracardiac conduit and permeable pulmonary artery (pulsatile Fontan). An Amplatzer duct-occluder device was implanted in the pulmonary artery entering from the femoral vein. Follow-up by means of clinical examination, imaging, and catetherization was pursued.


RESULTS
Case 1, patency fenestration, Qp/Qs: 0.7/1. Case 2, closed fenestration, Qp/Qs; 1.3/1. We obtained immediate occlusion with 6/4 and 8/6 devices, respectively; pressure recordings revealed modification of the arterial morphology to biphasic; pulmonary pressure dropped 2 mm Hg in the first patient, without alteration in the second case; no changes in SaO2 were registered. Time of fluoroscopy was 57 and 45 minutes, respectively. Follow-up was maintained for 2.8 and 2.3 years, respectively. In patient 1, headaches disappeared and the fenestration was occluded with an Amplatzer septal-occluder one year later, raising SaO2 to 96%; no complications occurred nor was recanalization of the pulmonary artery needed in either case.


CONCLUSIONS
Percutaneous occlusion of patent pulmonary artery in patients with Fontan type circuit is a feasible and effective procedure, and avoids overload of the single ventricle.
Gamboa
Ricardo
R
Sección de Cardiología Pediátrica del Institute de Cardiología y Cirugía Cardiovascular Fundación Favaloro, Buenos Aires, Argentina. rgamboa@ffavaloro.org
Mollón
Francisco P
FP
Ríos Méndez
Raúl E
RE
Cayré
Raúl O
RO
Cazzaniga
Mario
M
Arroyo
Graciela M
GM
Gutiérrez
Diego F
DF
D002404:Catheterization; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000379:methods