title: Customized covered stent graft for percutaneous closure of Fontan baffle leak.
abstract: We report the innovation of both a partly-covered and completely-covered, variable-diameter, balloon-expandable stent that was custom-designed by NuMed, Inc for percutaneous closure of a baffle leak after total caval pulmonary connection (TCPC). A 50-year-old patient, born with tricuspid atresia, who had undergone TCPC, developed severe persistent cyanosis due to a right-to-left shunt through a TCPC baffle leak. Re-operation was deemed too high risk. Therefore, considering his complex anatomy, a custom-made, partly-covered, tapered, balloon-expandable stent was designed and successfully deployed. Months later, the shunt recurred at the junction of the covered to uncovered stent cells; subsequently, a second fully-covered, custom-made, tapered stent was implanted with an excellent outcome. The use of covered or partly-covered customized variable-diameter stents for closure of baffle leak after TCPC is feasible and resulted in marked clinical improvement. Customized balloon-expandable stents may be superior to traditional cylindrical stents because of better anchoring and apposition.
authors: Division of Cardiology, St Paul’s Hospital – University of British Columbia, Vancouver, Canada.
authors: Ronald K
authors: RK
authors: Binder
authors: Fabian
authors: F
authors: Nietlispach
authors: Ronald G
authors: RG
authors: Carere
mesh_terms: D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D003490:Cyanosis / Q000209:etiology; D004867:Equipment Design; D018729:Fontan Procedure / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D012086:Reoperation; D015607:Stents; D017211:Treatment Failure; D016896:Treatment Outcome; D018785:Tricuspid Atresia / Q000601:surgery*
chemical_list: D011138:Polytetrafluoroethylene