Occlusion of Sano conduit with the Amplatzer vascular plug: a reliable method for staged elimination of accessory pulmonary blood flow in single ventricle palliation.
BACKGROUND
Staged palliative surgery is often required to regulate pulmonary and systemic blood flow in children with complex congenital heart disease. Accessory sources of pulmonary blood flow have been utilized to provide satisfactory pulmonary blood flow after Glenn anastomosis in select patients. Prolonged exposure to increased flow can lead to elevated pulmonary arterial pressures and volume loading of the ventricle, potentially limiting candidacy for Fontan completion.


OBJECTIVE
To review the feasibility, technique, and outcome of transcatheter closure of the Sano conduit utilizing the Amplatzer Vascular Plug (AVP).


METHODS
All patients who underwent device closure of the Sano conduit with an AVP were reviewed retrospectively. Patient demographics, indications, procedural details, and patient outcomes were reviewed. Hemodynamic changes before and after occlusion of the Sano conduit were compared. A P value < 0.05 was considered significant.


RESULTS
Between 2005 and 2009, 11 male patients underwent Sano occlusion with an AVP. Average weight was 8.8 ± 2.2 kg. The Sano was occluded from both antegrade (n = 6) and retrograde (n = 5) approaches. Arterial saturation and mean pulmonary artery pressure both decreased significantly after Sano occlusion [86.9 ± 4.9% to 82.6 ± 4.9% (P < 0.001) and 14.1 ± 5 mm Hg to 12.8 ± 4 mm Hg (P < 0.05), respectively]. Conduit diameter averaged 3.6 mm (range 3.1-4.4) 13 months after Stage I palliation. The conduit was closed using a 6 mm AVP in nine patients and a 4 mm AVP in the other two. The ratio of AVP size to conduit diameter was 1.5 ± 0.27. There were no procedural complications and all patients at least 2 years of age have undergone Fontan completion.


CONCLUSIONS
The Sano conduit can be left open in select patients who do not tolerate closure after Glenn anastomosis. It can be closed safely and effectively using the AVP. © 2010 Wiley-Liss, Inc.
Gordon
Brent M
BM
Loma Linda University Medical Center, Loma Linda, CA, USA. brgordon@llu.edu
Hashmi
Aijaz
A
Kuhn
Micheal A
MA
D001794:Blood Pressure; D006328:Cardiac Catheterization / Q000295:instrumentation*; D005240:Feasibility Studies; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D010166:Palliative Care; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011652:Pulmonary Circulation; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome