title: Closure of Fontan fenestration with the use of covered stents: short- and mid-term results in a cohort of 50 patients.
abstract: OBJECTIVE
  The use of covered stents to close fenestration in total cavopulmonary connection is presented.
  
  
  METHODS
  We retrospectively reviewed data of all patients undergoing the procedure of a covered stent to close fenestration of total cavopulmonary connection between 2005 and 2012.
  
  
  RESULTS
  A total of 50 patients met the inclusion criteria. Median age and weight were 7.7 years and 20 kg, respectively. Median interval between Fontan completion and fenestration closure was 13 months. The femoral vein was used in 42 patients and the jugular vein in eight patients. Of the patients, seven received two stents. Covered stents were CP stents in 42 patients and Atrium Advanta V12 in eight patients. BIB balloons were used in 24 patients and simple balloons in 18 patients. Simultaneous occlusion of venous collaterals was observed in five patients. Median procedural and fluoroscopy times were 49 and 8 minutes, respectively. Mean central venous pressure rose from 10 to 12 mmHg. Mean oxygen saturation increased from 88% to 96%. Full occlusion was confirmed in 47 patients. The remaining had residual shunts: two patients had intracardiac Fontan, and one patient had a stent that could not be fully opened. Following the procedure, five patients had local bleeding, and three delayed discharge 48 hours after the procedure. There was no thromboembolic event after a mean follow-up of 49 months.
  
  
  CONCLUSIONS
  Covered stent is a good option to close fenestration in extracardiac total cavopulmonary connection. It is safe, easily achievable with low fluoroscopy time, with very low risk of complication or failure. Good results are sustainable when excluding patients with none circular pathway.
authors.affiliation: 1Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C,Necker Hospital for Sick Children-HEGP,Assistance Publique des Hopitaux de Paris,Paris,France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Malekzadeh-Milani
authors.affiliation: 1Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C,Necker Hospital for Sick Children-HEGP,Assistance Publique des Hopitaux de Paris,Paris,France.
authors.forename: Magalie
authors.initials: M
authors.lastname: Ladouceur
authors.affiliation: 1Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C,Necker Hospital for Sick Children-HEGP,Assistance Publique des Hopitaux de Paris,Paris,France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Bajolle
authors.affiliation: 1Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C,Necker Hospital for Sick Children-HEGP,Assistance Publique des Hopitaux de Paris,Paris,France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bonnet
authors.affiliation: 1Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C,Necker Hospital for Sick Children-HEGP,Assistance Publique des Hopitaux de Paris,Paris,France.
authors.forename: Younes
authors.initials: Y
authors.lastname: Boudjemline
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005268:Femoral Vein / Q000637:transplantation; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007601:Jugular Veins / Q000637:transplantation; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult
keywords: Total cavopulmonary connection; covered stents; fenestration